Influence of revised public health standards on health equity action: a qualitative study in Ontario, Canada

Nadha Hassen,Heather Manson,Ingrid Tyler

doi:10.1186/s12939-017-0677-9

Abstract

BackgroundIn 2008, a revised set of public health standards was released in the province of Ontario, Canada. The updated Ontario Public Health Standards (OPHS) introduced a new policy mandate that required local public health units (PHUs) to identify “priority populations” for public health programs and services. The aim of this study was to understand how this Priority Populations Mandate (PPM) facilitated or hindered action on health equity or the social determinants of health through PHUs in Ontario.MethodsThis study used two sets of qualitative data that were part of a larger study. The first set of data was 16 semi-structured key informant interviews with policymakers involved in developing the OPHS and public health practitioners. The second set of data was the qualitative component of a role-based survey sent out to all the 36 PHUs in Ontario. Thematic content analysis was conducted to iteratively develop themes to answer the research question.ResultsWe identified six factors that both facilitated and hindered action on health equity and social determinants of health action in the province resulting from the OPHS and PPM. These six factors were grouped into three categories or themes: OPHS policy attributes (1. introducing new terminology, 2. allowing flexibility in implementation and 3. ensuring evidence-informed decision-making), health sector context into which the PPM was introduced (4. different understandings of health equity and 5. variability in existing partnerships) and implementation by PHUs (6. requirement to address the PPM).ConclusionsAlthough the revised OPHS and the PPM facilitated action on health equity and the social determinants of health, on the whole, this objective could have been better met. The mandate within the OPHS could have been strengthened with respect to promoting action on health equity and the social determinants of health through more clearly defined terminology, conveying a guiding health equity vision and uniting different PHU approaches to addressing health equity.

Highlights

In 2008, a revised set of public health standards was released in the province of Ontario, Canada
Based on our analysis, a broad understanding of how health equity is facilitated in Ontario emerged and this was depicted in a conceptual model
These six factors were grouped into three categories or themes: 1) Ontario Public Health Standards (OPHS) policy attributes 2) health sector context into which the Populations Mandate (PPM) was introduced and 3) implementation by the Public Health Unit (PHU)

Summary

Introduction

In 2008, a revised set of public health standards was released in the province of Ontario, Canada. As the standards required local PHUs to “consider the determinants of health when identifying priority populations”, the link to health equity was inferred [6] (p.24), [4, 7, 8] This mandate to identify priority populations, which we have called the Priority Population Mandate (PPM), was seen as enabling of action on health equity or the social determinants of health (SDOH) through the PHUs. with the revised public health standards, Pinto et al [3] states that the term ‘priority populations’ was used as a proxy for health equity and that the OPHS has a “lack of specificity” on health equity [3] (p.8). To support implementation of the PPM within PHUs in Ontario, we undertook the Priority Populations Project [9], which had the following objectives: To clarify what priority populations are To clarify why priority populations should be identified To provide support on how to identify priority populations

Objectives

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Results

Discussion

Conclusion