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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

Open Access 01-12-2020 | Public Health | Research

Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

Authors: Thea van Roode, Bernadette M. Pauly, Lenora Marcellus, Heather Wilson Strosher, Sana Shahram, Phuc Dang, Alex Kent, Marjorie MacDonald

Published in: International Journal for Equity in Health | Issue 1/2020

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
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Metadata
Title
Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems
Authors
Thea van Roode
Bernadette M. Pauly
Lenora Marcellus
Heather Wilson Strosher
Sana Shahram
Phuc Dang
Alex Kent
Marjorie MacDonald
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Public Health
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-01276-3

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