Abstract
IntroductionReducing health inequities is a stated goal of health systems worldwide. There is widespread commitment to health equity among public health leaders and calls for reorientation of health systems towards health equity. As part of the Equity Lens in Public Health (ELPH) program of research, public health decision makers and researchers in British Columbia collaborated to study the application of a health equity lens in a time of health system renewal. We drew on intersectionality, complexity and critical social justice theories to understand how participants construct health equity and apply a health equity lens as part of public health renewal.Methods15 focus groups and 16 individual semi-structured qualitative interviews were conducted with 55 health system leaders. Data were analyzed using constant comparative analysis to explore how health equity was constructed in relation to understandings and actions.ResultsFour main themes were identified in terms of how health care leaders construct health equity and actions to reduce health inequities: (1) population health, (2) determinants of health, and (3) accessibility and (4) challenges of health equity talk. The first three aspects of health equity talk reflect different understandings of health equity rooted in vulnerability (individual versus structural), determinants of health (material versus social determinants), and appropriate health system responses (targeted versus universal responses). Participants identified that talking about health equity in the health care system, either inside or outside of public health, is a ‘challenging conversation’ because health equity is understood in diverse ways and there is little guidance available to apply a health equity lens.ConclusionsThese findings reflect the importance of creating a shared understanding of health equity within public health systems, and providing guidance and clarity as to the meaning and application of a health equity lens. A health equity lens for public health should capture both the production and distribution of health inequities and link to social justice to inform action.
Highlights
Reducing health inequities is a stated goal of health systems worldwide
Within the three themes of population health, determinants of health, and accessibility, we capture how identities, oppressions, and the production of health inequities are constructed and how the political project of promoting health equity is understood within British Columbia (BC)‟s health care system
In a fourth theme of health equity talk, we explore how sets of social relations and institutional domains act as reciprocal environments for each other through examination of the challenges of talking about health equity work within both public health and health systems more broadly
Summary
Reducing health inequities is a stated goal of health systems worldwide. There is widespread commitment to health equity among public health leaders and calls for reorientation of health systems towards health equity. Complexity and critical social justice theories to understand how participants construct health equity and apply a health equity lens as part of public health renewal. Results: Four main themes were identified in terms of how health care leaders construct health equity and actions to reduce health inequities: (1) population health, (2) determinants of health, and (3) accessibility and (4) challenges of health equity talk. There has been growing recognition that despite improvements in health care, significant health inequities exist within and between countries This has been coined „the health equity gap‟ [1,2]. Reducing health inequities within and between countries is an ethical, social, and economic imperative and a goal of health systems worldwide [1,2,3]. According to Whitehead and Dahlgren [3], “equity in health implies that ideally everyone could attain their full health potential and that no one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstance.” Differences in age, gender, ethnicity, class, race, social class, religion, socioeconomic status or other socially determined circumstances should not impact resources and opportunities for health [6]
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