Abstract
The Canadian public health sector’s foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives - including readiness to engage in a social justice-based equity framework for public health - is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals.
Key Words: Public health practice, capacity building, health services research, disparities, health status, vulnerable populations
Résumé
Le secteur canadien de la santé publique, avec ses valeurs fondamentales de justice sociale et d’équité et son mandat de promotion de la santé des populations, est idéalement situé pour jouer un rôle de premier plan face aux iniquités en santé persistantes et inacceptables entre les groupes socialement défavorisés, marginalisés ou exclus et la population générale. On essaie beaucoup, en ce moment, de mieux comprendre les voies de l’équité en santé et d’élaborer des interventions efficaces en santé des populations pour réduire les iniquités en santé. Une mesure tout aussi essentielle et pourtant moins reconnue est de renforcer les capacités du secteur de la santé publique à élaborer, à mettre en oeuvre et à soutenir des initiatives de santé des populations axées sur l’équité - y compris la volonté d’employer en santé publique une grille d’équité basée sur la justice sociale. Malheureusement, il semble que la capacité actuelle du secteur canadien de la santé publique d’aborder les iniquités varie considérablement. La première étape, si l’on veut mettre au point une approche soutenue en vue d’améliorer les capacités d’agir sur l’équité en santé, est de déterminer ce qu’une telle capacité implique. Notre article définit un « cadre conceptuel de la capacité organisationnelle pour une action de la santé publique en matière d’équité », ancré dans l’expérience des champions de la santé publique canadienne sur la question de l’équité, pour orienter la recherche, le dialogue, la réflexion et l’action sur le renforcement des capacités en santé publique et atteindre les objectifs d’équité en santé.
Mots Clés: pratique en santé publique, renforcement des capacités, recherche en services de santé, disparités d’état sanitaire, populations vulnérables
Footnotes
Acknowledgements: This work was funded by a CIHR Catalyst Grant (Health Equity). We thank Dr. Marcia Anderson DeCoteau for her input into framework development, Lisa Jorgensen for graphic design, and Caitlan Gibbons for research assistance.
Conflict of Interest: None to declare.
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