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What is health equity?
Significant and persistent inequalities in health exist across population groups and communities in Canada. These include differences in lifespan, self reported health, rates of disease, and other indicators. While some of these variations are related to individual biology or lifestyle factors, the majority of differences in health status are related to socio-economic inequality.
Research shows that unequal access to income, employment, housing, education, food and other social determinants of health goes hand in hand with unequal health outcomes. “Health equity concerns those differences in population health that can be traced to unequal economic and social conditions--that are systemic and avoidable – and thus inherently unjust and unfair.” (Source: Unnatural Causes)
Health inequities can be further understood through the health gradient. This means that the lower you are on the socioeconomic scale, the poorer your health. In Canada, there is a growing gap between the richest and poorest Canadians. Research tells us that the more unevenly wealth is distributed through a society, the more the health of the entire population suffers.
Which groups face the greatest health inequities?
Poverty and low socio-economic status is closely linked to health inequities. Certain groups and communities face disproportionate social and health inequities in Ontario. These include Aboriginal communities, people of colour (newcomers as well as long term Canadian residents and citizens), rural communities and women. Priority groups for health equity interventions will vary by place and time, and may involve other intersecting factors such as disability, immigration status or sexual orientation.
How is equity related to health promotion?
Health equity is fundamental to health promotion. The Ottawa Charter names equity as a pre-requisite for health, together with social justice. Because most inequities are socially created, rather than the result of individual choices we make, remedies need to address social factors. Through the lens of health equity, health promoters have a more nuanced recognition of how the key determinants of health affect different groups, and how policy and programming interventions can reduce inequities.
In Canada, there is increasing recognition that health equity analysis is necessary to develop effective interventions. For those in health promotion, this means asking critical questions informed by health equity at each stage of their work – policy and strategy, designing actions and programs, and implementation and evaluation – so that long-term health outcomes can be improved for all groups and communities.
Planning for health equity
Health equity is more than equality of access to culturally competent services. It means ensuring greater equality of opportunity to education, employment, housing, food security and inclusion for all. Most importantly, it means ensuring improved health outcomes for all population groups. Because health status can vary across different regions and within groups in the same community, it is important to understand and address the needs of large populations, sub-populations, communities and individuals. To achieve health equity, we must combine broad population level approaches with more targeted interventions.
If we want to reduce health inequities, we require data that pertains to sub-population groups (including race, language, ethnicity) region and neighbourhood so that appropriate interventions can be developed. High-level, aggregate statistics are not enough as this can hide wide variations. This type of data is not yet adequately, or consistently, available in Ontario.
As it can be difficult to predict how any given program will impact health equity, new assessment tools are being developed to help health promoters anticipate likely outcomes at the planning stage itself. Known as Health Equity Impact Assessments, Health Equity Audits, or Health in all Policies, these approaches use health equity analysis to understand how a particular policy or program will influence the distribution of improved health throughout a given population. Such initiatives are relatively recent in Canada, although they have been in use in the UK, Europe, Australia and New Zealand for some time.
Where to go for more information
 Health Nexus Learning Resources
 Building Capacity for Equity and Health Promotion ( Collaborative project with the Health Equity Council)
Smoking Cessation—Working with Diverse Populations (Slides)
Primer to Action: Social Determinants of Health
First Steps to Equity. Ideas and Strategies for Health Equity in Ontario 2008-2010. Patychuk D and Seskar-Hencic D. November 2008, Toronto
Health Equity Council
Social Inequities in Health and Ontario Public Health
Background Document
Penny Sutcliffe, Sandra Laclé, Isabelle Michel, Claire Warren, and Vera Etches
Sudbury & District Health Unit
Pete Sarsfield, Northwestern Health Unit
Charles Gardner, Simcoe Muskoka District Health Unit
Health Equity: Programs, Projects and Practice
A Healthy, Productive Canada: A Determinant Of Health Approach
Final Report of Senate Subcommittee on Population Health
Report: The State of Public Health in Canada 2008 – Addressing Health Inequalities
Public Health Agency of Canada
Unnatural Causes – is inequality making us sick?
World Health Organization Social Determinants of Health Commission
Ottawa Charter for Health Promotion
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