Systemic and damaging health inequities have been increasingly on the policy agenda across the world in the last decade. A number of European countries have been leading the way in developing comprehensive health equity strategies. This paper highlights the great potential of comprehensive strategies to ground and connect the kinds of policy, investment, program and social changes needed to address complex determinants of health and reduce deep-seated inequities. We have identified a number of key elements of these strategies and success conditions for their implementation:
- high-level national strategic commitment
- consistent focus on the social determinants of health
- thoughtful selection of targets and indicators to drive the strategy and design for evaluating its impact
- mechanisms to steer and coordinate policy within and beyond governments
- strong linkages from the national to local level, with considerable local and community =level autonomy to adapt and innovate
- coordination among policy actors and across sectors
Although many different factors and considerations must be taken into account when developing health equity strategy for Canada, the experience and insights of other countries provides valuable lessons to be learned. Comprehensive European strategies provide many examples of policy and programs addressing systemic inequities, and demonstrate that action is possible. While driving the health equity agenda requires more than national strategies, such as continued public awareness and concern, innovation in delivering programs, and commitment from the community, together, these examples give an outline of promising directions that can be built upon. Towards this same goal of learning from others, Wellesley earlier commissioned a paper from health policy expert Denise Kouri on promising practices addressing equity within Canadian Regional Health Authorities. In the absence of a national strategy on health equity or determinants of health, and given the complex constitutional responsibility for health and social policy across federal, provincial and territorial levels, it may be that coordinated regional and local strategies offer one of the most significant opportunities for policy and community-level action. This paper reviews innovative directions taken by RHAs across the country.