Diane Dyson is Director of Research & Public Policy, Strategic Initiatives Unit at WoodGreen Community Services, and is guest blogging for us today. You can read her blog at http://belongingcommunity.wordpress.com.
A few days ago, the Saskatoon Poverty Reduction Partnership, an intersectoral approach to poverty spearheaded by the Saskatoon Health Region, released an update of its progress over the past three years on health equity among its residents, and its plan for the next five years. The approach taken by the Saskatoon Health Region serves as an example of how collaborative efforts can work to solve some of the harder social problems we face.At a recent Health Equity Forum hosted by Wellesley Institute, Dr. Cory Neudorf, Chief Medical Health Officer for Saskatoon Health Region, described the lessons learned over the past five years in his city.
1. Build a strong evidence base.
Robust data made the case for the need to change local health interventions. A 2006
Health Disparity by Neighbourhood Income study compared a set of low- and high-income neighbourhoods with each other and with the City average and found wide health disparities. Research found that low-income neighbourhoods, lying in the shadows of a leading acute-care children’s hospital, reported half the immunization rates of higher income neighbourhoods and four times the infant mortality rates. In these poor neighbourhoods, life expectancy was dropping.
Saskatoonians were appalled to find some of the highest levels of urban inequality in Canada were within their own neighbourhoods.Under Dr. Neudorf, the Health Region set about building a stronger evidence base. The result was the 2008 report, Health Disparity in Saskatoon: Analysis to Intervention, co-authored with Dr. Mark Lemstra. The report scanned over 10,000 articles for evidence-based policy solutions to the inequities identified. With further consultation, they were able to identify some concrete options for Saskatoon.Dr. Neudorf also worked with the Canadian Population Health Initiative and colleagues like Dr. David McKeown, Toronto’s Medical Officer of Health, and epidemiologist Dianne Patychuck to produce a cross-Canadian examination in the Reducing Gaps in Health: A focus on Socio-Economic Status in Urban Canada report. It was the first time the issue had been looked at nationally at such a small geographic level. (Around the same time, the Public Health Department in the City of Toronto produced a parallel report, The Unequal City, showing similar levels of disparity.)Three strategic directions emerged: a housing strategy, an employment strategy for Aboriginals, and a poverty-reduction strategy.
2. Build political will.
Data like these got people to the table, ready to talk and ready to look for solutions. Dr. Neudorf intentionally began to test public awareness and receptivity. Out of that came 200 community consultations and randomized surveys of 5,000 residents (including those without phones) exploring possible solutions and their levels of commitment to them. Forty-six policy options with a strong popular base were identified in areas such as income, housing, education and aboriginal self-governance.
Dr. Neudorf purposefully looked to include people beyond the “usual suspects” in exploring solutions to these problems. Business leaders, people in poverty with “first voice,” Aboriginal groups, faith groups, community associations, and others who weren’t usually at policy tables were asked to weigh in. The wider community found consensus on about twenty of the policy options.After convening another community roundtable, Dr. Neudorf asked community leaders and organizations to commit to a newly-minted and broad-based Leadership Group, out of which a smaller Coordinating Group and more specifically focused Action Groups emerged.
3. Work across sectors.
Because health disparities have roots in many other fields, they are “wicked problems,” as Wellesley’s Director of Policy Bob Gardner calls them, with no agreed solution and requiring multiple players. Dr. Neudorf explained this work has to be done in coalitions and partnerships – as evidenced by the 63 letters of support which lead off the 2008 report.Dr. Neudorf worked with the already-established Saskatoon Regional Intersectoral Committee to develop a community action plan on the range of social determinants of health. More focused community action groups emerged out of this plan.The City of Saskatoon, local school boards, and other regional agencies also launched a common data portal, CommunityView, to make data sharing among human service organizations easier and to improve community planning.As Saskatoon’s Medical Officer of Health, Dr. Neudorf also began to re-shape the delivery of public health services, building health equity audit tools. Low-income schools also became one of the new areas of intervention, despite some pushback from parents. Immunizations were also enhanced. Health programs underwent equity audits, identifying barriers to quality health care at both the patient and the service level.
Finally, the Region of Saskatoon formed the Poverty Reduction Partnership to develop a common plan, which has just been launched. Stakeholders are also exploring innovative ideas such as an idea incubator, with seed money from local philanthropists, to respond to some of the proposals coming forward. The work of the Saskatoon Poverty Reduction Partnership can be found at www.saskatoonpoverty2possibility.ca.
The Region of Saskatoon has committed to advocating for real change in the region, recognizing that poverty levels are determined by the public’s tolerance of them. Public health units, Dr. Neudorf explained, can lead the way by doing the research, implementing evidence-based interventions, reporting regularly on progress made, and facilitating intersectoral solutions to reduce health disparities.The idea that poverty and inequality lead to poorer health outcomes is not new. Dr. Neudorf began by referring to the now commonplace civic themes of health disparities, health equity, and closing the gaps. What has shifted, is the field of public health’s return to an examination of the significance of the wider social determinants of health and how “non-health” interventions can be one of the best forms of prevention.
To watch Dr. Neudorf”s presentation at the Wellesley Institute’s Health Equity Forum, click
here.
Social policy can’t just be about addressing the easy issues – there are very few – but has to tackle really deep-seated and complex problems such as poverty, health disparities or homelessness. I just published an article on promising community-driven directions for addressing such fundamental inequalities and the policy frameworks needed to address such “wicked” policy challenges.
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