9. Health Equity and Health Promotion

Resource Rationing

The process of controlling resources when they are scarce, to whom we will make these scarce resources available to, and why

• patient triaging (not enough beds, physicians, staff for everyone)

• general funding for health care (Canada Health Transfer — allocating scarce resources to the provinces)

Ontario’s COVID 19 Vaccination Program:

Stage 1 - Vaccine quantity

Estimated over 2M doses expected

Ontario’s COVID 19 Vaccination Program:

Stage 1 - Population to be Vaccinated

• residents, essential caregivers, and staff for congregate care settings for seniors

• health care workers

• adults in First Nations, Métis, and inuit populations

• adult recipients of chronic home health care

Ontario’s COVID 19 Vaccination Program:

Stage 1- Distribution Sites

• initially, two pilot sites, followed by selected hospital sites

• LTC home and Retirement Homes as soon as feasible

Ontario’s COVID 19 Vaccination Program:

Stage 2 - Vaccine Quantity

Increasing stock of vaccines available

Ontario’s COVID 19 Vaccination Program:

Stage 2 - Population to be Vaccinated

Expanded for health care workers, long-term care homes, retirement homes, home care patients with chronic conditions, and addition First Nation communities and urban Indigenous populations

Ontario’s COVID 19 Vaccination Program:

Stage 2 - Distribution Sites

Expanded vaccination sites

Ontario’s COVID 19 Vaccination Program:

Stage 3 - Vaccine Quantity

Vaccines available for every Ontarian who wants to be immunized

Ontario’s COVID 19 Vaccination Program:

Stage 3 - Population to be Vaccinated

All eligible Ontarians

Ontario’s COVID 19 Vaccination Program:

Stage 3 - Distribution Sites

Widely available across Ontario

Vaccine Distribution and Equity

The question of who should get a vaccine, when, and why (health policy), is a question about resource allocation and rationing, one that involves thinking carefully about equity

Health Equity

The absence of systematic disparities in areas of health more or less advantaged social groups

Health Inequities

The systematic disparities associated with circumstances that place some groups at a further disadvantage in terms of achieving health or having opportunities to be healthy

Social Determinants of Health

• social, political, and economic conditions in which people are born, live, work, play, and socialize

• these conditions have been shaped by distributive public policies that allocate financial, human, and physical resources at global, national, and global levels

Embrett and Randall (2014):

What did their paper review?

• systematic literature review designed to investigate the state of social determinants of health and health equity policy analysis research

• focus on AGENDA SETTING part of the stages heuristic

Embrett and Randall’s Article…

What were the weaknesses?

• lack of focus on how social, economic, and political environments influence political agendas

• lack of examination of relationships between government institutions, interest groups, and political ideas

• focus on a single element of theoretical accounts of policymaking

• failure to use a recognized policy analysis theory

Why don’t SHD/HE researchers use policy analysis theories?

• HE is an ethical concept

• point out… “this distribution of ___ was unfair”

• HE tells us what is fair/ unfair or right/ wrong

What are healthy public policies designed to do?

To enable people (with the correct environment) to lead healthier lives by creating access to healthier choices — making healthy choices easier/ the only choice

• enhancing health equity

• reducing health disparities

Why does stages heuristic have limited applicability?

It describes policy making as a linear process — BUT policy policy is often erratic and random

SHD/HE issues do not receive as much policy attention as expected due in large part to 5 main challenges…

What are they?

1) multiple causation between social conditions and health outcomes

2) lack of technical feasibility of policy solutions

3) life course perspective of policies that do not have immediate impact

4) dominance of other policies (i.e. biomedical solutions)

5) difficulty obtaining data that relate social conditions to health outcomes

Policy Formation/ Implementation:

Gamble and Stone (2006)

Address the multiple causal factors contributing to racial inequalities and suggest that gathering causal data is the primary inhibitor to policy development; government took no policy action, so their response was to provide addition resources to investigate the causes of the inequities — no significant contribution to policy change

Policy Formation/ Implementation:

Clavier et al. (2012)

Describe the progression of a SHD/HE initiative into the evaluation phase of the policy process; policy procedures and community decision makers did not adapt to the changes to resource allocation recommendations = policy failure