Measuring equity: what we heard from the field and next steps by Steve Barnes

Equity – a blog

Ontario’s Ministry of Health and Long-Term Care (MOHLTC) has identified equity as a key component of quality care. The Ministry has developed a Health Equity Impact Assessment (HEIA) to support improved health equity, including the reduction of avoidable health disparities between population groups. HEIA also supports improved targeting of healthcare investments—the right care, at the right place, at the right time. And that is what this blog covers. Join us in the conversation.

Measuring equity: what we heard from the field and next steps

Recently, the Equity MAgIC group and the Wellesley Institute hosted a roundtable to discuss how to use measurement to drive equity into action in healthcare. A range of experts presented on how to use data and indicators; how to build equity into quality improvement and system transformation; and how electronic health records can use real-time data to provide better healthcare to vulnerable populations.

Roundtable participants then broke into working groups to focus on how to build equity into system drivers; incorporate equity measures into healthcare planning; build momentum for health equity, even in tough times; and use evidence to drive local action. Ten guiding themes and recommendations came out of these working groups.

  1. Have clear starting points
    It is important to determine early what you want to achieve and what you need to get there. This includes being explicit about the inequities that you are trying to address, identifying and communicating the root causes of inequities, and being clear about language and definitions.
  2. Be selective: think big, but get going
    We need to focus on specific variables; we cannot try to measure and manage everything at once. This means focusing on areas where we know that it is possible to make a difference. Think about areas that the public knows and understands as a starting point, for example, gender health inequities.
  3. Ask the right questions to collect the right data
    This means being smart about what we need to know. Currently the right data is not collected at point of care. For example, we lack critical data that connects health system needs and usage with income, education, receipt of welfare, food bank usage, and housing status.
  4. Collect – and value – different kinds of data
    Complete the statistical and administrative data that already exists by adding qualitative data – evidence that tells stories can influence the public and decision makers. Local data is also important and must be valid, which can be ensured by involving the community in creating and capturing evidence, and translated to the grassroots level, where people can decide how to use it.
  5. Look for new ways to use the data you already have
    We cannot afford to wait until we have perfect data, so we need to find innovative ways to act on what we already know. For example, hospital discharge processes link patients to primary care. Analyzing this data can determine whether patients are getting the right care, at the right place, at the right time.
  6. Use and share tools for measuring and acting on equity
    A range of equity-focused tools already exist, like the Ontario Ministry of Health and Long-Term Care’s Health Equity Impact Assessment. Tools can be made mandatory to ensure widespread uptake or the Ministry of Health and Long Term Care and other health leaders can indicate that greater emphasis on health equity is on the way and healthcare service providers, Local Health Integration Networks (LHINs), and other key players in the healthcare system can get a head start by using these tools now.
  7. Embed equity and equity data in accountability regimes
    One way to drive change in health systems is to link targets with incentives. Outcomes must be systematically linked to targets, and the targets must be ones that are able to be controlled by the body or agency. Accountability should exist at multiple levels, but real change can be made by linking to executive compensation.
  8. Think local, but coordinate
    Each community can identify what it needs to focus on, but information, resources, and lessons learned must be shared. This means identifying the levers of change at a local level and empowering communities to make their own decisions, including how to spend funds.
    One strategy to facilitate sharing and coordination is to use common equity-focused tools and planning to identify priorities and LHINs can play a key coordination role.
  9. Be open – share
    Promoting a health equity agenda means making sure that people know about health equity and are talking about it. Focus on wide dissemination and use language that is understandable.
  10. Look for opportunities… and act
    Even in tough times, opportunities for action always exist. Identify projects that have political support and make a business case that demonstrates that acting on equity is cost-effective. We need to make longer-term arguments, but we must also recognize what drives decision makers and offer short-term ‘wins’.

These ten lessons provide a framework to further build the growing movement to drive health equity from strategic commitment into practice. What the MAgIC discussions show is that there is an appetite in the field to act on equity. Ministry, LHINs, and other system leaders need to work with people across the system to build on this potential and drive lasting action on health equity.

About the Author:

Steve Barnes is a Policy Analyst at the Wellesley Institute. He holds a MA in political science from Victoria University of Wellington, New Zealand and has published on political leadership and political socialization. Prior to joining the Wellesley Institute Steve worked as a policy advisor for the Government of Ontario. He has also held positions in the New Zealand public sector and at Victoria University. Steve’s policy interests include understanding how policy decisions made outside of the health sphere affect health outcomes and creating policy solutions that address unequal and unfair health outcomes.

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