Exploring Intersectoral Action and Community

Engagement for Health Equity: Newfoundland

and Labrador’s Western Health Region

PHABC 2013

November 5, 2:45 – 4:15

Presenters

Lesley Dyck

Knowledge Translation

Specialist

National Collaborating Centre

for Determinants of Health,

ldyck@stfx.ca

@lesleyanndyck

@nccdh_ccnds

www.nccdh.ca

Diana Daghofer

Principal

Wellspring Strategies

Rossland, BC

diana@wspring.ca

Workshop Objectives

• Explore strategies to advance health equity

through intersectoral action and community

engagement

• Use interactive progressive disclosure to explore a

case study on collaborative and intersectoral action

• Compare the case study with participants’

experiences with social determinants and health

equity initiatives.

Agenda

1. Grounding the conversation – key concepts

2. Introduction to the progressive disclosure process

3. Presentation #1: The Case – description, issues, activities

4. Group Discussion

5. Presentation #2: The Case – the challenges and how they

were resolved

6. Group Discussion

7. Applicability to your context?

8. What does the evidence say about the effectiveness of

intersectoral action on the SDOH and health equity?

National Collaborating Centres for Public Health

Our audience:

• Practitioners, decision

makers, and researchers

working in public health

• Organizations in Canada’s

public health sector

Our work:

• Translate and share evidence

to influence interrelated

determinants and advance

health equity

Our focus:

• Social determinants of

health & health equity

National Collaborating Centre for Determinants of Health

Health Equity

Health equity exists when all people can reach their

full health potential and are not disadvantaged from

attaining it because of their race, ethnicity, religion,

gender, age, social class, socioeconomic status,

sexual orientation or other socially determined

circumstance.

Adapted from Dahlgren and

Whitehead, 2006

The Social Determinants of Health

• The social and

economic factors that

affect well-being

• The social

determinants intersect

and interact

• The health of groups

are the result of a

complex mix of factors

http://nccdh.ca/resources/entry/social-determinants-of-health-

the-canadian-facts

Promising Practices

Community engagement

and intersectoral action

have both been identified

as promising practices in

public health to help

address the social

determinants of health and

advance health equity.

http://nccdh.ca/resources/entry/10-promising-practices-guide

Sudbury & District Health Unit, 2009

Community Engagement

• Involving the community in the development,

implementation of policies, programs and services

• Empowering communities, building relationships

• Interventions are more likely to be meaningful,

appropriate, and responsive

Intersectoral Action

• The solutions to health inequities lie outside the

health sector

• To intervene on the social determinants of health,

partnerships are required

• Strong relationships,

common understanding,

shared objectives

“Leadership is about influence that moves individuals, groups,

communities and systems toward achieving goals that will

result in better health” (Betker & Bewick, 2012, pg. 31)

What is leadership?

There is a call for public health

leadership for health equity at all levels –

we all have a role to play!

Case Study

• Problem-based learning using case

studies

• Presentation: Description of the context,

issues addressed, activities undertaken

• Group work: Think critically about the

information presented – analyze,

synthesize, and consider solutions

Case study

Central question we

wanted to explore with

this case study: What

are the structures and

processes that support

leadership for community

engagement and

intersectoral action in a

regional health authority?

Population: 79,460

Declining faster than the

provincial average

Median age = 44

Size:

7-10 times the size of PEI

Main town:

Cornerbrook (25% of the

regional population)

Geography:

hills, isolated coastal

communities

Key SDOH data:

– 15.3% below the low-income line (same as the national

average, slightly over provincial average)

– Average income $22,100

– 39.1% of the labour force collected employment

insurance at some point in 2011, down from 42% in 2009

– 26.6% aged 25 to 54 had no high school certificate,

diploma or degree, compared to 22% provincially

Wellbeing data:

– 82% reported a sense of community

belonging, compared to 80.1%

provincially, and 60.3% nationally

– 53.5% rated their health status as

very good or excellent, compared to

60.3% provincially

Key elements:

“Vision: The vision of Western Health

is that the people of Western

Newfoundland have the

highest level of health and

well being possible – Your

Health Our Priority.”

From: Western Health, Strategic

and Operational Plan, 2011-2014

“Values: The core values of Western

Health offer principles and a

guiding framework …

– Respect

– Equity

– Transparency

– Advocacy

– Collaboration

– Excellence

– Innovation

– Accountability”

1. Vision, mission and values for the organization

2. Leadership - Population health is an Executive

responsibility

“The most important things we do at a strategic executive

level [are to] set health equity as a priority and go out and

develop relationships.”

- Dr. Susan Gillam, CEO

3. Operations - Population health and health equity

are found within organizational and funding

structures:

– Population Health Branch structure

– 2 lines of business:

1) promoting health and well-being

2) preventing illness and injury

(Western Health, Strategic and Operational Plan, 2011-2014)

4. Staff training

Building a Better Tomorrow:

– Funded through the Primary Health Care Transition Fund

(Government of Canada)

– Modules emphasize determinants of health, population health

and health promotion, and building interdisciplinary teams

– Modules are based on needs of staff, and ensure teams work as

effectively as possible with each other and community members.

– Some modules provided as e-learning

5. Intersectoral approach

Linkages Committee:

- Across departments (Advanced Education and Skills, Housing,

and Child, Youth and Family Services)

- Meets quarterly, aimed at inter-departmental cooperation

- Includes issues such as communication, information sharing, and

support for specific clients

“On paper, collaboration is what we do, but at the core, our efforts

are about maintaining relationships. That is the biggest strength of

the Linkages Committee. We have mutual respect for each

other .”

- Michelle House, VP of Population Health

6. Community Engagement

a) Local Community Advisory Committees – Groups of

interested individuals or organizational representatives meet

regularly to address community issues; guided by community

needs assessments.

“Having the community contribute ideas engages them to a much

greater extent than having health staff suggest a complete program.

When they contribute to the solution, residents have a vested

interest in making it succeed.”

- Tammy Priddle, Regional Director of Health Promotion and

Primary Health Care

Community Engagement (continued):

b) Community Needs Assessments – conducted every 3 years

using telephone interviews augmented with focus groups

c) Western Regional Wellness Coalition – one of six provincial

coalitions which provide leadership, coordination and support for

local health promotion initiatives, as well as opportunities for

citizens to get involved in local community actions

Group Work (20 minutes)

Health equity work is often not “named” as such, but frequently happens as part of intersectoral and community engagement activities.

Do you have similar structures and processes to those at Western Health? How do they support health equity work in your organization?

Operational:

• Vision, values

• Leadership

• Org Structure

• Training

Intersectoral:

• Linkages

committee

Community engagement:

• Local community

advisory committees

• Community needs

assessments

• Western Regional

Wellness Coalition

Challenges

• Time – collaboration takes time; there is no quick fix

• Recruitment and Retention of Volunteers – is difficult but

essential for building community health champions

• Outcome Evaluation – difficult to link intersectoral and

community engagement activities directly to health outcomes

• Language – is necessary for building a common

understanding across sectors and in the community

• Use of Evidence – needs to be supported with knowledge

translation around the social determinants of health and

health equity

Keys to Success

• Fostering leadership – through educational sessions for staff

and community members (Building a Better Tomorrow), and

through the Community Advisory Committees

• Working intersectorally – by setting a clear direction for

this type of work at the top, integrating into position

descriptions and workload allocations, training the staff and

board, incorporating into organizational newsletters, and co-

locating staff

• Building organizational capacity – by valuing the work at

the CEO level, hiring positions dedicated to community

engagement, continuing to nurture a culture of collaboration,

and celebrating successes

Group Work (20 minutes)

Do you experience similar challenges to those at Western Health?

How would you apply their keys for success to your own situation? Are there others?

Challenges:

• Time

• Recruitment/retention of volunteers

• Outcome evaluation

• Language

• Use of evidence

Keys to success:

• Fostering leadership

• Working intersectorally

• Building organizational

capacity

What’s the evidence?

Intersectoral Action

We did a rapid systematic literature

review asking: “What is the

impact/effectiveness of intersectoral

action as a public health practice for

health equity?”

– Total of 17 articles included:

1 systematic review, 14 quantitative

studies & 2 qualitative studies

– Difficult to determine how observed

outcomes relate to intersectoral

action

http://nccdh.ca/resources/entry/assessing-the-impact-

and-effectiveness-of-intersectoral-action-on-the-SDOH

… there is some support for an impact on

health equity outcomes:

• positive effect for children, especially for early literacy among children of low-income mothers

Intervene in early childhood

• improve housing and employment conditions, evidence of impact for other social determinants of health is limited

Upstream interventions

• employment/working conditions, child literacy, dental health, housing, and organizational change

Midstream interventions

• increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks.

Downstream interventions

What’s the evidence?

Community engagement

We are currently doing a rapid systematic literature review

focused on community engagement as a public health

practice for health equity:

Questions:

1. What is the impact (direct and indirect) of community

engagement on the community and community members

who are involved?

2. What is the experience of community engagement for the

communities and/or community members involved?

– How are power and control in interventions addressed?

– What role do communities play?

– What is the quality of the engagement?

Community engagement questions (continued):

3. What level of engagement occurs? Are different levels

of engagement associated with different outcomes?

4. What are the processes and approaches for community

engagement? How can public health implement an

inclusive practice at all levels of the planning cycle?

What is the optimal intensity of community

engagement?

Expanded and adapted from:

Kelly et al, 2007:63-64

Popay et al. 2007

Other resources:

NCCDH: www.nccdh.ca/resources

(search community engagement,

intersectoral action)

Get involved:

• Sign up for our E-News

• Visit www.nccdh.ca

• Check out our Resource Library

• Sign up for Health Equity Clicks:

Community

• Review our list of Canadian

Organizations

• Take part in webinars, conferences &

workshops

25 gets you 10:

crowd sourcing great ideas

• One card per person

• Write clearly:

“One exciting idea +

an action you are considering”

• No name on index cards

• 5 rounds of scoring 1 to 5

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Top 10 as chosen by you

Contact Us

National Collaborating Centre for Determinants of Health

St. Francis Xavier University

PO Box 5000, Antigonish, NS B2G 2W5

NCCDH@stfx.ca and CCNDS@stfx.ca

Phone: (902) 867-5406 Fax: (902) 867-6130

www.nccdh.ca and www.ccnds.ca

@NCCDH_CCNDS #sdoh #healthequity