Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, 4th Floor, Toronto, Ontario, Canada M4X 1K2.
Int J Equity Health. 2012 May 25;11:28. doi: 10.1186/1475-9276-11-28.
Promoting health equity is a key goal of many public health systems. However, little is known about how equity is conceptualized in such systems, particularly as standards of public health practice are established. As part of a larger study examining the renewal of public health in two Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis of relevant public health documents related to equity. The aim of this paper is to discuss how equity is considered within documents that outline standards for public health.
A research team consisting of policymakers and academics identified key documents related to the public health renewal process in each province. The documents were analyzed using constant comparative analysis to identify key themes related to the conceptualization and integration of health equity as part of public health renewal in Ontario and BC. Documents were coded inductively with higher levels of abstraction achieved through multiple readings. Sets of questions were developed to guide the analysis throughout the process.
In both sets of provincial documents health inequities were defined in a similar fashion, as the consequence of unfair or unjust structural conditions. Reducing health inequities was an explicit goal of the public health renewal process. In Ontario, addressing "priority populations" was used as a proxy term for health equity and the focus was on existing programs. In BC, the incorporation of an equity lens enhanced the identification of health inequities, with a particular emphasis on the social determinants of health. In both, priority was given to reducing barriers to public health services and to forming partnerships with other sectors to reduce health inequities. Limits to the accountability of public health to reduce health inequities were identified in both provinces.
This study contributes to understanding how health equity is conceptualized and incorporated into standards for local public health. As reflected in their policies, both provinces have embraced the importance of reducing health inequities. Both concepualized this process as rooted in structural injustices and the social determinants of health. Differences in the conceptualization of health equity likely reflect contextual influences on the public health renewal processes in each jurisdiction.
促进健康公平是许多公共卫生系统的一个关键目标。然而，对于公共卫生系统如何在制定公共卫生实践标准时概念化公平问题，人们知之甚少。作为一项审查加拿大安大略省和不列颠哥伦比亚省（BC）公共卫生更新的更大研究的一部分，我们对与公平相关的相关公共卫生文件进行了分析。本文的目的是讨论在概述公共卫生标准的文件中如何考虑公平问题。
一个由政策制定者和学者组成的研究小组确定了与每个省公共卫生更新过程相关的关键文件。使用恒比分析对这些文件进行了分析，以确定与安大略省和 BC 公共卫生更新中健康公平的概念化和整合相关的关键主题。通过多次阅读对文件进行了归纳编码，并通过多次阅读实现了更高层次的抽象。制定了一系列问题来指导整个分析过程。
在这两套省级文件中，健康不平等都以类似的方式定义，即不公平或不公正的结构性条件的结果。减少健康不平等是公共卫生更新过程的明确目标。在安大略省，解决“优先人群”被用作健康公平的代理术语，重点是现有计划。在 BC，将公平视角纳入其中增强了对健康不平等的识别，特别强调健康的社会决定因素。在这两个省份中，都优先考虑减少获取公共卫生服务的障碍，并与其他部门建立伙伴关系以减少健康不平等。在这两个省份中，都确定了公共卫生在减少健康不平等方面的问责制存在局限性。
本研究有助于了解健康公平是如何在地方公共卫生标准中概念化和纳入的。正如其政策所反映的那样，这两个省份都认识到减少健康不平等的重要性。两者都将这一过程概念化为植根于结构性不公正和健康的社会决定因素。健康公平概念化的差异可能反映了每个司法管辖区公共卫生更新过程的背景影响。
