van Roode Thea, Pauly Bernadette M, Marcellus Lenora, Strosher Heather Wilson, Shahram Sana, Dang Phuc, Kent Alex, MacDonald Marjorie
Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada.
Int J Equity Health. 2020 Sep 15;19(1):162. doi: 10.1186/s12939-020-01276-3.
Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity.
Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization.
We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government.
Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.
减少健康不平等并改善健康结果的卫生系统政策和计划对于应对不公正的健康社会梯度至关重要。将健康公平作为优先事项是解决健康不平等问题的根本，但在卫生系统中实施具有挑战性。需要采取策略来支持对健康公平进行有效的优先排序。
遵循省级政策建议，即在所有公共卫生项目中应用健康公平视角，我们在早期实施阶段研究了不列颠哥伦比亚省各卫生当局内部的健康公平优先排序情况。我们对来自六个卫生当局和卫生部的55名高级管理人员、公共卫生主任、区域主任和医疗卫生官员进行了半结构化定性访谈和焦点小组讨论。我们采用归纳性持续比较分析法，以复杂性理论为指导进行分析，以确定优先排序的关键要素。
我们确定了卫生系统内两个根本转变所需的七个关键要素。1）通过非正式组织进行优先排序包括为健康公平创造系统价值并让健康公平倡导者参与进来。2）通过正式组织进行优先排序要求明确将健康公平列为优先事项，为健康公平指定资源，在决策中要求体现健康公平，建设能力和竞争力，并在卫生系统和政府各级协调全面的方法。
虽然为健康公平创造共同价值至关重要，但以社会正义为支撑的健康公平需要在结构层面加以体现，以支持有效的优先排序。政府和各部门内部进行优先排序对于促进其他层面的优先排序是必要的。卫生系统内的所有层面都应对在战略计划和目标中明确纳入健康公平负责。健康公平倡议需要专门的资源，包括为公共卫生基础设施提供充足资源、培训以及招聘具有公平专业知识的工作人员以发展能力和系统能力。
