Community Health Centres Of Greater Toronto Health Equity Plan

Leading LHINs (Local Health Integration Networks) in Ontario and Regional Health Authorities across the country have prioritized reducing systemic health inequities.  They have encouraged and enabled comprehensive local health equity strategies and health care providers and institutions to develop equity plans.

In a unique innovative example of sectoral coordination, Community Health Centres of Greater Toronto have developed a common sector-wide health equity plan.  Wellesley was happy to have partnered with CHC-GT to facilitate discussions and draft the plan.

All CHCs committed to a common seven-point strategy:

1. Build equity into priority setting and service planning: An explicit planning framework – incorporating community engagement, a common equity lens, and the use of an equity impact assessment tool – will ensure equity is embedded in routine planning within each CHC.
2. Align equity with system drivers and priorities: CHCs will highlight the role health equity plays within a number of current system priorities, including quality improvement, chronic disease prevention and management, Alternative Levels of Care (ALCs), wait times and sustainability.
3. Embed equity in performance measurement and management: CHCs will build on extensive international, provincial and local efforts to develop and measure explicit equity targets. Specifically, CHCs will develop and implement a sector-wide performance measurement and management strategy that embeds equity and uses common equity indicators.
4. Target for equity impact: CHCs will build into strategic and operational planning explicit targeting strategies based on evidence and analysis of healthcare issues and community involvement in planning and priority setting.
5. Build equity into health promotion: Health promotion activities that reach only the well-informed or most connected run the risk of widening health disparities. CHCs will lead the sector in employing a strategy of “targeted universalism” to ensure health promotion campaigns address the impacts of poverty and unemployment, enable community development and civic engagement, and build resilient communities.
6. Build in social determinants: CHCs will position the client-centred care agenda as an opportunity to reach well beyond healthcare and empower communities to address inequities caused by social and economic policy as well as underlying structures.
7. Drive equity through innovation: CHCs will continue to address equity in collaboration with mental health, ethno-cultural and other community-based providers and to share and build upon successes. The emerging model of the CHC as a multi-service hub in high-need areas will be carefully evaluated for its potential in reducing inequities.

CHCs will adapt these strategic directions to their community’s needs, priority populations and identified access barriers. To build in learning and accountability, each CHC will prepare an annual performance report on the activities and impact of the equity directions as adapted to their specific context, and present this report, key lessons learned on promising practices and front line innovations, and present them to an equity symposium organized annually by the CHC-GT forum.

Toronto CHCs will also address three common challenges:

1. Share interpretation resources and capacities to address a crucial barrier to equitable care.
2. Build equity into performance measurement and management: developing a set of performance metrics that assess not just access and quality of health care services, but equity-focused health promotion and community engagement and social participation.
3. Develop a systematic strategy for non-insured populations: CHCs will build on existing work for this highly vulnerable population to identify service gaps and develop consistent policies and procedures for assessing and supporting people without insurance, including sector-wide arrangements with hospitals, common data collection, and resource sharing mechanisms across the sector.

While the conditions, resources and overall health situation will vary a great deal, the overall framework and idea of coordinated local community-based action is relevant in communities well beyond Toronto.  Hopefully, this plan can contribute to analyzing and acting on health equity in communities across the province and country.