While high-level commitment to health equity is increasingly widespread and Ontario’s Excellent Care For All Act enshrines equity and population health as key principles of a high quality system, embedding equity into policy and service delivery is a continuing challenge. Luckily a wide range of policy and program planning tools and frameworks are being developed that can help drive equity into practice.
Some of these are about enabling widespread use of Health in All Policies approaches — recognizing that the determinants of health are affected by sectors well beyond health care, this approach emphasizes that impact on population health needs to be considered in policy development across all spheres of government. Previous broad European initiatives such as ‘Closing the Gap’ and ‘Determine’ and the current Equity Action portal analyze the foundations of health inequities and identify policy action needed to address these structural roots. The ‘Crossing Bridges’ initiative carries this forward to provide resources and develop capacities to enable HiAP approaches to be solidly implemented. One recent working group reported on how this could be done in education sectors.
Another very interesting initiative is the Gradient Evaluation Framework; focusing on children, youth and their families, this project develops a comprehensive framework to enable policy makers to identify key levers and interventions to reduce health inequities. It seeks to identify the ‘gradient friendliness’ of policy directions and interventions — “i.e. their potential to level-up the gradient.” One of its strengths is being well attuned to the internal complexities and cycles of policy development. The project applied this framework to what can be done in the European context to level health inequities for children and youth and produced a book on The Right Start to a Healthy Life.
The lessons are clear: there are many innovative methods and tools we can draw on to operationalize health equity. While social determinants of health are certainly complex and ‘wicked’ problems like deep-seated health inequities can seem intractable, initiatives such as these show that action is possible. Considerable expertise and experience is being built up on how to drive health equity into policy and community action.