Using documentation to develop grounded advocacy for equity focused public health work

Abstract

Abstract Health inequity is a global concern. The Public Health Unit (PHU) of a local hospital conducts activities in partnership with many actors, aiming at decreasing the health gap. This commission highlights the need to advocate for shared participation, influence and control and for methods that make health care available, accessible and acceptable for all. A platform for such advocacy includes analysis of interventions based on evidence-informed strategies. How may PHU:s activities (2019) have contributed to health equity? Analyses build on documentation in the Health Equilibrium Methodology system which draw on Social Cognitive Theory, critical reflection and quantitative measurements. PHU participated in 81 meetings on the strategic level. Common values and trust, more stable in long-term partnership, facilitated development of population-focused activities that could support marginalised groups. On the population level the Unit participated in 170 activities. Examples were bicycle courses, family centred talks with dietician, tobacco talks with youths and groups for mothers of Somalian origin. Common strategies were to support self-efficacy by confirming and communicating knowledge, to use reciprocal determination by drawing attention to environmental factors, to affect outcome expectations by highlighting links between lifestyle and health and to facilitate healthy habits by making guidelines accessible. Critical reflection highlighted barriers for making use of general advice. Data indicate that professional reflection is needed to implement shared participation, influence and control and that trust-building is dependent on stable presence. Professional reflection, systematically documented and taken into account is needed to fully use health care potential to ensure Right to health for all. Trust takes time to build but creates possibilities for inhabitants to raise health issues from their perspective, enabling meaningful support Key messages To take the full potential of public health work into account actors should use systematic documentation focusing on processes, avoiding to reduce evaluation to numerical reports. Health care professionals that aim at closing the health gap need to distance themselves from their personal perspectives by using systematic critical reflection of their practice.