Public Health Ontario’s (PHO) mission is to enable informed decisions and actions that protect and promote health and contribute to reducing health inequities. Many of the causes of such inequities relate to social and environmental factors including income, social status, gender, education, as well as the physical environment, including housing. The activities, projects, reports, research and partnerships outlined below illustrate our work that directly relates to reducing health inequities.
Ministry of Health and Long-Term Care's Health Equity Impact Assessment Tool
The MOHLTC's HEIA tool allows users to identify how a program, policy or initiative will impact population groups in different ways. The end goal is to use this information to maximize positive impacts and reduce negative impacts that could potentially widen health disparities between population groups. The tool, which includes a Public Health Unit Supplement, was developed in collaboration with many partners, including PHO.
Health Equity Assessment: Facilitators and Barriers to the Application of Health Equity Tools
A health equity assessment tool (HEAT) provides systematic steps for health policy makers, program planners and researchers to assess their initiatives through a health equity lens. Health Equity Assessment: Facilitators and Barriers to the Application of Health Equity Tools is an analysis of the application of selected HEATs from Australia, New Zealand, the United Kingdom and Canada.
The analysis was conducted to inform the application of HEATs in the Canadian context, and specifically in Ontario. The report is organized into two parts:
The Health Promotion Foundations online course provides an introduction to the field of health promotion in Canada. This self-directed course provides information on:
Module one provides an introduction to the field of health promotion and provides an overview of key health promotion definitions and concepts, including:
The Ontario Health Profile (OHP) describes the health status of Ontarians by focusing on key public health issues that have an impact on the whole of the population. The OHP presents a series of stories, using current data and visuals, which provide an overview of the complex factors that influence and shape Ontario’s population health status.
The OHP expands our understanding of the health of Ontarians and gives decision-makers and practitioners the information they need to take action. Where feasible, it includes sections on populations at risk, as well as differences between populations, which provide the user with information to assess health inequities.
Ontario health profiles are also available as infographics. The Determinants of Health infographic displays differences in the demographics of Ontario’s population that are known to impact health. Other infographics, including those on obesity and mental health, among others, also highlight disparities in health.
Summary Measures of Socioeconomic Inequalities in Health, is a report that describes five key scientific and technical approaches to measure socioeconomic inequalities in health, and includes advantages, limitations and applications of these approaches.
The Priority Populations project, comprised of the Priority Populations technical report and Focus On: A Proportionate Approach to Priority Populations, was developed to guide public health units in identifying priority populations. This work is essential for health units to meet the Ontario Public Health Standards (OPHS) mandate that “the board of health shall use population health, determinants of health and health inequities information to assess the needs of the local population, including the identification of populations at risk, to determine those groups that would benefit most from public health programs and services (i.e., priority populations).”
PHO is committed to addressing the health protection and promotion needs of diverse populations. This means that specific projects or aspects of our projects include a focus on population groups that are at higher risk or share an unusual burden of illness or risk factors. Some specific examples from current work include:
The Ministry of Health and Long Term Care (MOHLTC) has funded 45 communities across Ontario to participate in the Healthy Kids Community Challenge (HKCC). The aim of the HKCC program is to reduce the prevalence and prevent childhood overweight and obesity. Local program initiatives will promote key themes such as physical activity and healthy eating. HKCC communities are encouraged to consider health equity in program development at the local level, with the HKCC Resource Centres providing support as each theme is rolled out.
PHO is leading the provincial evaluation of the HKCC in partnership with MOHLTC and other provincial and community partners. As part of the HKCC evaluation PHO will conduct a HKCC Aboriginal Stream Evaluation, using a set of principles developed in collaboration with representatives of the six communities that were funded through Aboriginal Health Access Centers/Community Health Centers.
Hepatitis C is ranked as the most burdensome infectious disease in Ontario. At risk populations include people who use injection drugs, immigrants from countries with higher rates of hepatitis C, men who have sex with men, Aboriginal people and those who are or have been in correctional facilities. New drugs to treat hepatitis C are significantly more effective than previously available treatments, however these drugs are very expensive. PHO is assessing strategies to increase access to these newer drugs. For more information, please see Recommendations for the public health response to hepatitis C in Ontario.
This project identifies that applying an equity lens to data analysis is a key strategy for strengthening infectious disease surveillance at PHO over the next five years. Actions will include assessing existing data gaps on priority populations, initiating strategies to address these gaps and advancing the routine use of social determinants of health and behavioural risk factors in data analyses.
First Nations health clinics in northern Ontario often face challenges such as limited access to expertise in infection prevention and control. PHO provides opportunities for health care workers to learn and adopt infection prevention and control best practices, while investigating unique dissemination methods less used in the southern areas of the province. For more information see PHO in Action: Lori Schatzler.
The Ontario Burden of Infectious Disease study (ONBOIDS) identifies sexually transmitted infections as the third most burdensome group of infectious diseases for females. The Provincial Infectious Disease Advisory Committee-Communicable Diseases (PIDAC-CD) Sexually Transmitted Infections working group is currently reviewing and revising selected chapters of the 2009 Sexually Transmitted Infections Case Management and Contact Tracing Best Practice Recommendations with a specific focus on gender-based differences.
The Smoke-Free Ontario – Scientific Advisory Committee 2.0 project will include considerations of health equity across the report when examining tobacco control policies, interventions that address these policies, and how these interventions have been implemented. Health equity is an important cross-cutting consideration in the development of the report.
In Ontario and globally, social determinants of health influence Tuberculosis (TB) epidemiology, and are key considerations for TB prevention and control. Our recent report on TB in Ontario in 2012 affirms that persons born outside Canada and Aboriginal peoples continue to bear a disproportionate burden of TB in Ontario. A new Tuberculosis Working Group under the Provincial Infectious Diseases Advisory Committee-Communicable Diseases (PIDAC-CD) will advise PIDAC-CD on evidence-informed guidelines and will provide advice related to TB prevention and control, considering the social and structural determinants that affect high burden populations.
The Universal Influenza Immunization Program has been offered by MOHLTC since 2000 and provides free influenza vaccine to all individuals six months of age and over who live, work or attend school in Ontario. MOHLTC has undertaken a review in order to identify opportunities to improve effectiveness and efficiency of the program. As part of the review process, PHO will lead the scientific and technical components with the support of a scientific working group. Part of our work will involve reviewing groups at highest risk for influenza complications.
1. A realist evaluation of knowledge translation interventions for the use of evidence in Health Equity Impact Assessment
This research project, funded by the Canadian Institutes of Health Research, focuses on the use of evidence when completing HEIA tools. For more information, see Research in Action: Dr. Ingrid Tyler.
2. Social inequalities in ischemic heart disease incidence in Ontario: monitoring socioeconomic trends over time and identifying intervention targets
Examining socioeconomic trends in ischemic heart disease (IHD) in Ontario from 2001 to 2009, this study will examine interventions aimed at reducing socioeconomic inequalities in IHD in different contexts.
3. The effectiveness of population versus targeted high-risk intervention strategies for reducing population and social inequalities in type 2 diabetes in Canada, 2011-2021: a modelling study
This study will estimate population and social inequalities in 10-year diabetes incidence using the Diabetes Population Risk Tool (DPoRT) and estimate the number of diabetes cases prevented or delayed under varying scenarios.
4. Locally driven collaborative projects
“What are the best indicators that Ontario public health units can use to monitor and guide their work in addressing the social determinants of health?” This is the research question that is being addressed in one of our Cycle 3 Locally Driven Collaborative Projects (LDCP). The focus of this project is to develop and pilot test indicators that could be used to monitor and measure the performance of local public health units and boards of health in addressing social determinants of health and reducing health inequities. Visit our LDCP page to find out more.
PHO’s Locally Driven Collaborative Projects bring together academics, researchers, and representatives from health units so they can develop and implement research protocols that explore a topic, intervention or program related to an important public health issue.
5. Reducing inequalities in the burden of human papillomavirus (HPV) related diseases in Canada through optimal vaccination and screening policies: a multidisciplinary model-based approach.
In collaboration with researchers in Quebec and BC, this study, funded by the Canadian Institutes of Health Research, examines reducing inequalities in the burden of human papillomavirus (HPV) related diseases in Canada through optimal vaccination and screening policies.
We cannot achieve the outcomes inherent in our mission without actively engaging with partners in government, local public health, the health care system, not-for-profit sector, and academia. Work continues with the following partners:
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