The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Fraser Health Authority, Suite 400, 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada.
Int J Equity Health. 2017 Oct 27;16(1):187. doi: 10.1186/s12939-017-0677-9.
In 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.
This 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.
We 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).
Although 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.
2008 年，加拿大安大略省发布了一套经过修订的公共卫生标准。更新后的安大略省公共卫生标准（OPHS）引入了一项新的政策任务，要求地方公共卫生部门（PHU）为公共卫生计划和服务确定“优先人群”。本研究旨在了解安大略省 PHU 通过优先人群任务（PPM）促进或阻碍卫生公平或健康决定因素的行动。
本研究使用了两套定性数据，这些数据是一项更大规模研究的一部分。第一组数据是对参与制定 OPHS 和公共卫生从业人员的 16 名政策制定者进行的 16 次半结构化关键知情人访谈。第二组数据是对安大略省所有 36 个 PHU 发送的基于角色的调查的定性部分。进行了主题内容分析，以迭代开发主题来回答研究问题。
我们确定了六个因素，这些因素既促进了卫生公平和健康决定因素行动，也阻碍了安大略省 OPHS 和 PPM 产生的行动。这六个因素分为三类或主题：OPHS 政策属性（1.引入新术语，2.允许实施灵活性，3.确保循证决策）、引入 PPM 的卫生部门背景（4.对卫生公平的不同理解，5.现有伙伴关系的可变性）和 PHU 的实施（6.需要解决 PPM）。
尽管修订后的 OPHS 和 PPM 促进了卫生公平和健康决定因素的行动，但总的来说，这一目标本可以更好地实现。OPHS 中的任务本可以通过更明确的术语来加强促进卫生公平和健康决定因素的行动，传达一个指导卫生公平的愿景，并团结不同 PHU 解决卫生公平的方法。
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