Equity Dialogues: Equity in Decision-Making and Service Delivery

Equity and population health are among the fundamental principles enshrined in Ontario’s Excellent Care for All Act, and equity has become broadly accepted as a key health system/provider goal. But how can we drive implementation? How do we ensure that equity is embedded within system/organizational planning processes, performance management, deliverables and incentives. Further, how do we effectively align equity with health system drivers and priorities?

Wellesley and the Equity MAgIC project have been actively working on pushing the equity agenda forward. Our goal is to ensure equity is consistently part of decision-making and service delivery – across the spectrum of planning, needs assessment, strategy and program development, and performance measurement and management in health care. From its starting point as a CIHR-funded research grant to develop an equity measurement tool, disseminating the outcomes of the research has led to a series of dialogues among diverse audiences on how to drive equity into action. We just held a very successful second stakeholder forum (stay tuned for proceedings and reports).

We invited health and health equity thought leaders to share their perspectives in a series of blog posts published by Longwoods. The goal of this series is to generate awareness and further dialogue on embedding equity in key system and organizational drivers such as quality improvement and performance management. Adalsteinn Brown set out the challenges in the first blog in the series: noting that while Canada has been a world leader in social determinants of health and equity thinking, we have been less effective in implementing the changes necessary to reduce inequities. He argued that systematic measurement, public reporting and building equity into accountabilities will be key drivers of change.

In this week’s blog, Arlene Bierman, lead investigator of the hugely influential POWER study, argues that because inequities in health are greater than inequities in access to and quality in care, we need to work well beyond the acute care system, including addressing upstream social determinants. She also highlighted the need for gender sensitive solutions, focusing on primary care and community services, and emphasized that where there was an organized strategy for quality improvement informed by performance measurement, such as for coordinated cancer care, few inequities were observed.

Upcoming blogs will focus on the cost of not acting on inequities, lessons learned from leading jurisdictions around the world, local community-level action and the need for sophisticated evaluation strategies for these complex challenges. I will be writing next week on the key elements of a comprehensive equity strategy.