By Gillian Kranias, HC Link
My work in healthy community projects has always been driven by a passion for equity. Through community collaborations, we work for change to transform the living situations of equity-seeking groups (to which we sometimes do/sometimes don't belong) for the benefit of all. At the local level, we draw links and we ask important equity questions, like "What differences among community members might cause some folks to be negatively impacted (or not reached) by our organizing, our actions and our programs? What steps can we take to remedy this?" Often enough, we make positive progress. But at the system-level (policies and large-scale services) change is harder to impact. Still, we stay committed and hope for more.
On a very hopeful day last week (November 26th) some fifty people gathered in a room at CAMH - with thirty others connected online - for an event titled: Realizing the Potential of Health Equity Impact Assessment (HEIA). The HEIA tool, developed by the province, is "a decision support tool which walks users through the steps of identifying how a program, policy or similar initiative will impact population groups in different ways." Among the presenters, not all spoke to the ministry's tool – there are other tools out there too. All of the tools hold a promise to enhance our efforts to advance equity through policy and service changes.
Here are some of the goodies I gained from the various presenters:
- Ayasha Mayr Handel commented that taking a health equity focus can tap into a positive place for everyone.
- Dr. Ketan Shankardass' research reveals that the use of health equity tools is making an impact in places where the tools are either mandated, or resourced (i.e. where a capacity building team supports implementation) ...wouldn't it be best to have both!
- Erika Hanley highlighted that "understanding the culture of poverty" is a key competency for staff and teams implementing the HEIA tool. Her team in Simcoe-Muskoka used the Sudbury District Health Unit's video and resources Let's Start a Conversation About Health . . . and Not Talk About Health Care at All. And they are now creating a panel of folks with lived experience to assist in guiding and facilitating their HEIA work.
- Dr. Corey Neudorf and his team at the Saskatoon Health Region decided to lead by example. Looking at glaring health disparities in local data, they are pressing departments to answer "what are we doing now?" and "what could we do better?" Their key message is: let's provide equal service for equal need.
- Cynthia Damba noted that The Hospital for Sick Kids has an online learning module on Social Determinants of Health and Health Equity. I checked this out, and it's great; it emphasizes "asking the right questions" and guides health care providers to make the links, and to use their privilege to take action on health equity issues.
- Karen O'Connor of the CMHA shared some of her organization's experiences using the HEIA tool and talked about the need for both top down AND bottom up action. She found the HEIA tool helped build transparency and intention.
Half way through the afternoon, a speaker from the floor representing a [mental health services] consumer group patiently appealed to the presenters asking "how can we reduce the gap between the talk about HEIA and related tools, and the work of groups [like ours] in the community". This contribution brought thoughtful commentary from the speakers, and sparked some dynamic insights during participant dialogues at the end of the session. Such as:
- We need ground rules (e.g. "nothing about us without us") when we use these tools. Budget commitments need to support such ground rules.
- It's important to acknowledge the work of those before us; this work is not new. History and context is important.
- When we use the term "knowledge" in place of "evidence", it is easier to include people's lived experiences and qualitative data as contributing sources towards "knowledge-informed practice".
- Organizational culture and providers need to break down the "us vs. them" dichotomy. To support this, participant dialogues referenced both the Ottawa Charter for Health Promotion and Paulo Freire's Pedagogy of the Oppressed.
This afternoon of learning and exchange was an event of the HEIA Community of Interest https://knowledgex.camh.net/ke_workspace/heia_coi/default.aspx and Health Nexus was one of the co-hosts. I really appreciated all the efforts of the organizers and enjoyed meeting new people, as well as seeing a some familiar faces from our HC Link community.