Governance Leadership for Health Equity

Governance Leadership for Health Equity

Filling in for Axelle Janczur, Access Alliance Multicultural Health and Community Service

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Learning Goals: • Re-introduce the Health Equity Framework; • Review some examples of actions connected with using the HE Framework; • Demonstrate how HE Framework is the Health Equity Charter in action.

(Re-)Introducing the Health Equity Framework “A framework… [allows] health care organizations to improve health equity in the communities they serve.”

Source: Achieving Health Equity: A Guide for Health Care Organizations, produced by the Institute for Healthcare Improvement, Cambridge, Massachusetts, 2016.

The HE Framework was adapted and adopted in 2017 Equity-informed Planning & Evaluation Project Health Equity Project Leader Access Alliance Multicultural Health and Community Services Health Equity Project Capacity Building Partner Association of Ontario Health Centres

Health Equity Project Champions Chigamik, Planned Parenthood; North Lambton; Rideau; Somerset West; Témiskaming; and Women’s Health in Women’s Hands Community Health Centres Funder: Ministry of Citizenship and Immigration

Health Equity Framework Make health equity a strategic priority

Develop structures and practices to support health equity work

Take specific actions to address the multiple determinants of health on which CHCs can have a direct impact

Decrease all forms of organizational discrimination & oppression within your CHC

Develop partnerships with others to improve health and equity at societal/ population levels

Health Equity Framework

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Health Equity Framework

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Health Equity Framework Pillars • Make Health Equity a strategic priority: Establish organizational commitment towards health equity by making it an explicit strategic priority, by embedding it into the strategic plan, mission, vision, values, etc. • Develop structures and practices to support health equity work: Integrate in human resources, communications, performance measurement, planning and evaluation, data collection policies and practices 8

Develop Structures & Practices to Support Health Equity Work Chigamik Community Health Centre • Hire bilingual staff for intake • Train in cultural safety

Collect as close as can to 100% of mandatory indicators

Define the inequity or disadvantage for improvement

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Health Equity Framework Pillars • Take specific actions to address multiple determinants of health on which the organization can have a direct impact: Develop evidence-based strategies that work towards improving health outcomes for specific marginalized populations served. • Decrease all forms of discrimination and oppression within your organization: Work from the inside out and decrease all forms of organizational discrimination & oppression within your organization by implementing staff training around diversity, cultural competence, antioppression, anti-racism, human rights, anti-harassment, accommodation, accessibility policies.

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Access Alliance measures the % of clients being offered services in their language of choice

and hires interpreters and peer support based on this evidence.

They hired interpreters who speak Czeck/Slovak, Hindi/Gujurati, Arabic/French, Tamil, and Hungarian, based on these statistics.

Decrease all forms of organizational discrimination & oppression within your Org. Planned Parenthood: Anti-racism, antioppression training for staff annually; required for all new staff.

Somerset West CHC: Diversity audit of the agency; examining internal hiring practices and other HR practices and policies 12

Health Equity Framework Pillars • Develop Partnerships with Others to Improve Health and Equity at a Societal/Population Level: Develop multisector partnerships and coalitions with others, locally and regionally, including those who work directly with groups experiencing health disparities, and who share common priorities and vision around improving health equity at societal/ population levels.

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Many examples of partnerships with others to improve health and equity at societal/ population levels

Connecting the HE Framework with the HE Charter Having a common understanding and commitment to Health Equity is essential.

Using a HE Framework is the best way to put the HE Charter into action at every level of your centre.

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Make Equity a Strategic Priority: Inclusive Leadership in Governance 1. understanding equity, diversity and inclusion 2. engaging in behaviors and practices of equity 3. reflecting on your organizations values and beliefs 4. taking proactive action as a Board to create and sustain an inclusive organization

Develop structures and practices to support health equity work • Developing human resource policies and practices designed to ensure that the diversity of the communities we serve is reflected at all levels – volunteer, staff, management, and board - in our organizations.

• Developing evaluation strategies that measure health equity efforts and health equity results and using the evaluation data to continually improve health equity practices.

• Using equity as a measure of quality in delivering peoplecentred care.

• Sharing best practices and lessons learned in achieving health equity results.

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Take specific actions to address the multiple determinants of health on which CHCs can have a direct impact

• Assigning priority to population groups who have the greatest health needs and least access to services • Documenting the causes of, impacts of and potential solutions to health inequities.

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Decrease all forms of discrimination and oppression within your organization: • Developing anti-racism/anti-oppression strategies to identify, name and confront practices that reproduce oppression within our organizations. • Ensuring our policies, procedures and staff training meet the linguistic, cultural and other needs of the diverse communities we serve.

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Develop partnerships with others to improve health and equity at societal/ population levels • Involving the communities, we serve in the design and delivery of our programs.

• Collaborating with health partners and the broader community to ensure equity as an underlying goal of the health system.

• Supporting and collaborating with community groups who are challenging the social conditions that cause health inequities.

• Advocating for public policy responses proposed by communities to reduce health inequities.

• Contributing to building an integrated, high-performing health system with health equity as one of its underlying principles.

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Thank you, Miigwetch, Merci.

Heidi Schaeffer, (pronouns: she/her) Advancing Change Together (ACT) Special Projects Consultant |Consultant en projets spéciaux Alliance for Healthier Communities | Alliance pour des communautés en santé

Heidi@act-consulting.ca

@HeidiESchaeffer

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Governance Leadership for Health Equity

North Lambton Community Health Centre – June 2019

Presenter Disclosure Presenters: Kathy Bresett, Executive Director, North Lambton CHC Mac Redmond, Board Chair, North Lambton CHC Relationships to commercial interests: Grants/Research Support: none Speakers Bureau/Honoraria: none Consulting fees: none Other: none

Catchment • 2 Rural Sites

• 1 Urban Site • 1 First Nation Site • 1 Chronic Disease Site

Health Equity Framework

Make health equity a strategic priority

Develop structures and practices to support health equity work

Specific actions to address the multiple determinants of health on which CHCs can have a direct impact

Decrease all forms of organizationa l discriminatio n& oppression* within your organization

Develop partnerships with others to improve health and equity at societal/ population level

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Building the Foundation

Make health equity a strategic priority

2016-2020 strategic plan Organizational commitment towards health equity by making it an explicit strategic priority Monthly agendas (board and staff) include health equity as a standing item for discussion and updates on equity initiatives

Structures and Practices Develop structures and practices to support health equity work

• Board completed the Alliance Inclusive Leadership modules • Staff completing EQUIP modules • EQUIP Healthcare: https://equiphealthcare.ca/toolkit/ • Circles Canada partnership/program

Actions Specific actions to address the multiple determinants of health on which CHCs can have a direct impact

• HEP C, Harm Reduction Team • Housing Team • Transportation program • Health Equity Walk Through

Organizational Oppression Decrease all forms of organizationa l discriminatio n& oppression* within your organization

• Harm Reduction policy • Policies reviewed by Rainbow Health • Screening questions in interview • Onboarding training (Harm Reduction, EQUIP, awareness of local oppression/context)

Partnerships Develop partnerships with others to improve health and equity at societal/ population level

• LGBQ+ community of practice • Trauma and Violence Informed Care – community education

Question s

Women’s Health in Women’s Hands CHC

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Community Health Connections Notisha Massaquoi Executive Director June 13, 2019

Research at WHIWH - CHC

• Began in 1999 due to lack of published literature on health issues impacting racialized women • Difficult to develop effective programs without appropriate data • We needed to generate scientific knowledge to fill existing gaps

Health Equity Data tells Our Story • 97% of our clients are racialized ( 44% Caribbean, 15% African, 16% Latin American, 7% South Asian) • 26% identified not as Het. • 83% Female • 2% Male • 0.8% Transgender • 66.7% under 40 (31=ave) • 51% Post Secondary • 32% unemployed

• 63% household income less than $14,999 • 15% support 5 or more • 78% Born outside Canada • 10.5 visits per year • 45% Chronic Illness • 46% without OHIP • 78% addressing violence • 67% addressing sexual violence • 0.8% addressing addictions

Top 5% Service Users Category

Description

Encounters/Visits

30-66 (Ave= 39)

Income

62%< $15,000

Age

18-55 (Ave= 32)

# of WHIWH providers

1-6 (Ave=4.4)

# of Meds

3-24 (Ave =10)

Major Dx

HIV 15% Diabetes 25% Mental Health 75% -Anxiety 45% -Depression 45% -Bipolar 15%

Race-Poverty-Depression

$25,000-$29,999 $20,000-$24,999 2% $35,000-$39,999 2% 2% $30,000-$34,999 3% $40,000-$59,000 5% $15,000-$19,999 12%

0$14,99 9 74%

0-$14,999 $15,000-$19,999 $40,000-$59,000 $30,000-$34,999 $35,000-$39,999 $25,000-$29,999 $20,000-$24,999

Health Disparities as Directives New HIV diagnoses, total, Ontario, 2006-2015

Data provided to Ontario HIV Epidemiology and Surveillance Initiative (OHESI) by Public Health Ontario Laboratory.

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New HIV diagnoses by sex, Ontario, 2006-2015

Data provided to Ontario HIV Epidemiology and Surveillance Initiative (OHESI) by Public Health Ontario Laboratory.

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Percent of HIV diagnoses by sex, ACB, Ontario, 2009-2015

Data provided to Ontario HIV Epidemiology and Surveillance Initiative (OHESI) by Public Health Ontario Laboratory.

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Percent of female HIV diagnoses identified as ACB by LHIN (select), Ontario, 2011-2015

Data provided to OHESI by Public Health Ontario Laboratory.

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2017 Client Mapping 1.54%

York Region 1.54%

Peel Region 4.61%

1.15%

14.23%

14.23%

7.69% 2.69%

Hamilton – Wentworth Region 0.77% 8.84% Niagara Region 0.38%

21.15% 12.69%

4.61%

Durham 3.84%

Prevention Programs

Prevention Programs

Prevention Programs

WHIWH

ONTARIO CHCs

# of Clients included

896

217298

# of Clients not included

636

28736

Age 0-4 (%)

2.8

6.5

Age 5-9 (%)

0.0

5.3

Age 10-45 (%)

65.1

46.3

Age 46-64 (%)

27.8

26.5

Age 65-89 (%)

4.4

14.8

Age 90-104

0.0

0.6

Income Quintile 1 (%)

44.4

33.4

Income Quintile 2 (%)

23.3

21.6

Income Quintile 3 (%)

15.2

17.5

Income Quintile 4 (%)

7.7

15.1

Income Quintile 5 (%)

8.4

12.1

% Male

2.0

42.1

% Newcomer

48.5

14.0

Prevention Programs •

Cancer Screening

ICES

WHIWH No OHIP

Ontario CHC’s

Cervical

66.8%

78.33%

66.2%

Breast

72.2%

44.00%

62.7%

Colon

67.8%

31.22%

64.9%

THANK YOU!

Contact information: Email address: notisha@whiwh.com Web: www.whiwh.com

Twitter: @notishamassaqu!