Health Equity Systems Interventions

Governments have a key role in developing and maintaining health equity systems. All governments manage some aspect of how different groups of people experience well-being, and coordinate how each of us are supported by social welfare of various types:

• health care
• transportation
• housing
• revenue and taxation (corporate grants, tax breaks)
• labour (unemployment insurance, basic income)

Thus, some governments work to encourage health promotion and prevention activities across all departments (intersectoral models), including the implementation of ideas like Health in All Policies where governance is reoriented towards intersectoral action for well-being. Such health equity systems are maintained by an array of governance structures, such as policies (e.g. Quebec’s 2001 Public Health Act) and long-term strategies (e.g. Quebec’s 2016 Government Policy of Prevention in Health) as well as the use of use of governance tools, such as the Ontario Ministry of Health and Long-Term Care’s Health Equity Impact Assessment tool.

Neighbourhood environments are particularly useful units for intervention for planning and managing health equity systems since people tend to spend a lot of time in a few key neighbourhoods. Policies and programs at all levels of government and across departments manifest in the places where we live, work, study and play, and shape our well-being.

For example, how we each experience chronic stress across our lives will be shaped by the stressful aspects of our neighbourhoods (perhaps related to transportation networks or crime rates), and the resources that might also be present (such as affordable child care or calming green spaces). In turn, many major cities globally currently have specific neighbourhood planning strategies, such as the City of Waterloo’s Neighbourhood Strategy. Partners in neighbourhood-based community service organizations and private sector also contribute to health equity outcomes through their intentional and unintentional efforts.

Finally, given the normative quality of concepts such as equity, fairness and justice, there may be vigorous political debates that shape health equity systems. Some key questions include:

• Is health a right? 
• Is health care a right? 
• Where does the balance between individual and collective responsibility lie for poverty, social marginalization and health behaviours (e.g. drug use, physical activity, diet, relaxation)? 
• What is the role of health care in the broader health system? 
• To grow health equity, should we grow a stronger economy or directly invest in people?

Project Description

Existing research evidence suggests that chronic stress underlies some of the differences in health between populations: rich/poor, white/racialized/Indigenous, men/women, among other differences. Yet there is often very little evidence-based action, which this project hopes to contribute to solving.

In academia, stress is often studied in a fragmented way within disciplines such as psychology, sociology and psychoneuroimmunology. The Stresscapes project uses interdisciplinary and community-based approaches to develop interventions that help institutions address chronic stress at the neighbourhood level. It is important for cities to develop strategies to identify communities experiencing an overwhelming burden of chronic stress, and then work to address stressors and offer resources to improve health outcomes.

Framework

The project uses a computational linguistics framework based on social media analysis that was developed by Martin Sykora and his colleagues (EMOTIVE), to develop community-engaged intervention tools that inform urban planning by providing a dynamic look at stress across space and time. 

This work is partly based on a conceptual framework of environmental determinants of chronic stress and chronic disease published in 2012. This work has continued through a commentary for Canadian Psychology to outline the potential applications of this approach.

Research Project Team

The Stresscapes project involves an international collaboration of researchers including:

• Population health scientist: Ketan Shankardass, Wilfrid Laurier University
• Geographers: Colin Robertson, Principal Investigator, Wilfrid Laurier University; Rob Feick, University of Waterloo
• Psychologist: Krystelle Shaughnessy, University of Ottawa
• Information management scientist: Martin Sykora, Loughborough University

Learn More

Collaborators with the project have applied this approach to study the mental health implications of disasters such as hurricanes and terrorist attacks.

• Big data opportunities for social behavioral and mental health research
• A novel surveillance approach for disaster mental health
• Mental health surveillance after the terrorist attacks in Paris

Project Description

Ketan Shankardass leads the HARMONICS project at the Centre for Urban Health Solutions (St. Michael's Hospital) in Toronto. This project has conducted a series of realist explanatory case studies of governments that have tried to use Health in All Policies (HiAP), a collaborative approach that integrates and articulates health considerations into policymaking across sectors, to improve the health of all communities and people. Our research aims to better understand how to implement HiAP successfully.

Moving from a governance approach of working in policy silos (i.e. a ministry gets a specific mandate and dedicated budget and goes to work with little to no interaction with other ministries) to something more integrated, like HiAP, can be challenging. In our case studies, we are learning about what tools and strategies have helped, or not helped, to involve the participation of different sectors in this initiative.

To date, our team has conducted nine case studies, in Norway, Finland, Thailand, Ecuador, California, Scotland, Sweden, Quebec and South Australia. Publications ranging from decision-maker reports and databases, theoretical and methodological contributions, and evidence from our case studies can be found at harmonics-hiap.ca.

Research Project Team

• Ketan Shankardass, St. Michael’s Hospital, Wilfrid Laurier University
• Patricia O’Campo, St. Michael’s Hospital, University of Toronto
• Carles Muntaner, University of Toronto
• Lauri Kokkinen, University of Tampere
• Ahmed Bayoumi, St. Michael’s Hospital

Project Description

Governments know there are health inequities. They measure these inequities from time to time; they know what they can do to address them; but they generally haven't done much to address health inequalities since the early 1980's when the political landscape entered the Neoliberal Era. This lack of political will may reflect a lack of awareness about the problem itself, and an incomplete understanding of why there are health inequities in both the general voting public and the government. Our research team aims to fill this gap through research completed by faculty and students in cooperation with community and health system partners. 

This research project aims to study the levels of awareness and understanding of the Ontario public about income-related health inequalities. Currently, our team is working to develop educational interventions with partners in public health units to target subgroups of the population who are under-aware in an effort to grow political will for health equity interventions.

Research Project Team

• Maritt Kirst, Wilfrid Laurier University
• Aisha Lofters, St. Michael’s Hospital
• Carlos Quiñonez, Univerity of Toronto

Learn More

We've published a series of papers that have examined this topic using data from a 2010 telephone survey. 

• Shankardass K., Lofters A., Kirst M., and Quiñonez C. “Public awareness of income-related health inequalities in Ontario, Canada.” International Journal of Equity in Health. 2012 11:26.
• Lofters A., Slater M., Kirst M., Shankardass K., and Quiñonez C. “How Do People Attribute Income-Related Inequalities In Health? A Cross-Sectional Study In Ontario, Canada.” PLOS One. 2013 DOI: 10.1371/journal.pone.0085286.
• Kirst, M., Shankardass K., Singhal, S., Lofters, A., Muntaner, C., and Quiñonez C. “Addressing health inequities in Ontario, Canada: What solutions do the public support?” BMC Public Health. 2017 DOI: DOI 10.1186/s12889-016-3932-x