Understanding action on the social determinants of health: a critical realist analysis of in-depth interviews with staff of nine Ontario public health units

Raphael, Dennis; Brassolotto, Julia

doi:10.1186/s13104-015-1064-5

Cited by 23 publications

(28 citation statements)

References 11 publications

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“…In our report [ 9 ], we found that health equity was conceptualized in various ways, along a spectrum from a burden of disease approach on one end to a health equity approach on the other end. In addition, it has been shown that PHUs were working toward health equity in very different ways, from direct service provision to enhancement of socioeconomic conditions [ 11 ].…”

Section: Resultsmentioning

confidence: 99%

“…One of the reasons writing an overarching OPHS and PPM may have been difficult is because of the wide range of ways in which health equity has been operationalized in the province. Raphael and Brassolotto [ 11 ] discussed three differing approaches to addressing SDOH, 1) service delivery, 2) intersectoral and community, and 3) structural [ 11 ]. Pinto et al [ 3 ] identified that the recognition of “how equity is conceptualized” would assist in developing “more explicit, action-oriented and concrete steps” to address health equity (p.8).…”

Section: Discussionmentioning

confidence: 99%

“…In spite of barriers described above, and without formal evaluation, many respondents felt that overall the PPM was a step in the right direction and that “we can safely say that in some cases work to address the needs of priority populations as prescribed by the mandate has resulted in an increase in direct service provision to priority populations.” However, the PPM seemed to only address health equity from a service-delivery perspective and did not acknowledge that some practitioners and PHUs had intersectoral and community or structural approaches to health equity [ 11 ]. To successfully reap the benefits of a flexible policy that can be adapted at the local level, it appears necessary to establish and communicate a complete vision of the ways in which health equity is operationalized.…”

Section: Discussionmentioning

confidence: 99%

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

Hassen

Tyler

Manson

2017

Int J Equity Health

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Hassen

Tyler

Manson

2017

Int J Equity Health

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“…[11,12]That complements the health care provided by a physician and may potentially result convenience for patients to get their refills in minimum time spent dealing with prescription changes and combined medication management. [14,16] The role of the pharmacist has changed a lot over the last twenty year. A widely expansion in scope of practice has gone far beyond a traditional dispensing.…”

Section: Pharmaceutical Portfolio In Canadamentioning

confidence: 99%

Pharmacy Health System in Canada: An Adoptable Model for Advanced Clinical and Pharmaceutical Care

Nazir¹,

Taha²

2018

Journal of Applied Pharmacy

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The philosophy of patient care is a wide and complicated topic of literature. That is elaborated by different health institution to harmonize their local clinical activities. Undoubtedly, that is working successfully to satisfy patients, fulfill the requirement of clinicians and cover maximum mutual benefits within officially allocated budget. However, patient care has different comprehension in different demographic and socio-political setting. But, in general, the meaning, understanding and composition of clinical and pharmaceutical patient care may be same all over world. The pharmacists, clinicians and administration adopt, exercise and emphasize on certain parts depending upon the type of challenges, kind of patients and available health care facilities. Thus, the health care is an emerging field that always remained under consideration. The local and international experts like to work, contribute and improve it to enhance the public health. Even some time judiciary, parliament and local intelligentsia focus and emphasize to address some particular health related problems. So, we may need to elaborate the comprehension to satisfy the literature and logical need of health and medicine including identification of problems, designing treatment protocol and handling the complication of therapy. That may potentially improve the overall outcomes and maximize the patient’s benefit. After twenty five years the definition of pharmaceutical care is still unsatisfactory. The confusion remained about what this term comprises and how to distinguish it from other terms. The board of the Pharmaceutical Care Network Europe (PCNE) felt essential to rephrase pharmaceutical care and to answer the question: "What is Pharmaceutical Care ". The patient care is not perfectly incorporated into the health care system in most part of the world. However, pharmacy practice has shown positive attitudes toward patient care provision. Thus, an advanced working should focus to improve the understanding the concept of patient care and overcome barriers.

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“…Academics, for example, navigate review and funding structures that systematically privilege particular groups [14,15] and ideologies [16,17]. In public health practice, efforts to respond to social determinants of health have a tendency to become narrowly focused on behavioural interventions [18][19][20]. In policy settings, advancing policies to redress imbalances in the distribution of wealth, resources, and power lack traction [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

A tool to assess alignment between knowledge and action for health equity

Plamondon

2020

BMC Public Health

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Advancing health equity is a central goal and ethical imperative in public and global health. Though the commitment to health equity in these fields and among the health professions is clear, alignment between good equity intentions and action remains a challenge. This work regularly encounters the same power structures that are known to cause health inequities. Despite consensus about causes, health inequities persist-illustrating an uncomfortable paradox: good intentions and good evidence do not necessarily lead to meaningful action. This article describes a theoretically informed, reflective tool for assessing alignment between knowledge and action for health equity. It is grounded in an assumption that progressively more productive action toward health inequities is justified and desired and an explicit acceptance of the evidence about the socioeconomic, political, and powerrelated root causes of health inequities. Intentionally simple, the tool presents six possible actions that describe ways in which health equity work could respond to causes of health inequities: discredit, distract, disregard, acknowledge, illuminate, or disrupt. The tool can be used to assess or inform any kind of health equity work, in different settings and at different levels of intervention. It is a practical resource against which practice, policy, or research can be held to account, encouraging steps toward equity-and evidence-informed action. It is meant to complement other tools and training resources to build capacity for allyship, de-colonization, and cultural safety in the field of health equity, ultimately contributing to growing awareness of how to advance meaningful health equity action.

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Understanding action on the social determinants of health: a critical realist analysis of in-depth interviews with staff of nine Ontario public health units

Cited by 23 publications

References 11 publications

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

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

Pharmacy Health System in Canada: An Adoptable Model for Advanced Clinical and Pharmaceutical Care

A tool to assess alignment between knowledge and action for health equity

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