Health Equity/Social Determinants of Health
Health Equity/Social Determinants of Health 7
Mariam Naguib, Hon BA&Sc, MD (she/her/hers)
McGill University Faculty of Medicine and Health Sciences
Montreal, Quebec, Canada
Increasingly, pediatricians are asserting the urgent need for effective practices and policies to address child health inequities yet there is a paucity of data on practical approaches. According to the Institute of Health Improvement (IHI), health equity is paramount for a just society that moves towards better wellbeing for all, through a framework with 5 priorities: make health equity a strategic priority, develop structures and processes to support health equity work, deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact, decrease institutional racism within the organization, and develop partnerships with community organizations.
The objectives of this study were to: 1) Map out the current initiatives addressing health equity and 2) Explore the facilitators and barriers to achieving health equity in tertiary pediatric health care setting in Canada.
We conducted an environmental scan using semi-structured interviews and review of the grey and published literature. We interviewed at least one pediatric resident and one staff (including pediatricians, allied health professionals or administrators engaged in health equity) at all 17 pediatric tertiary care centers in Canada. The interview guide was structured using the IHI framework, to characterize the initiatives, as well as the facilitators and barriers, to address health equity. We performed a thematic analysis using NVivo. Codes were generated using an inductive and deductive approach, from which themes were identified.
Results: We conducted 41 interviews from Fall 2021-2022. Recent events, including Black Lives Matter and the COVID pandemic, fuelled health equity initiatives at both hospital and university level. The majority of institutions are in a reactionary state with few having formal strategic approaches to address inequities. The initiatives served a variety of priority populations: Indigenous, Black, migrants, rural communities, and children with disabilities, with focus differing based on geography and unique challenges faced by each institution. To achieve equity throughout an organization, equity at the staffing level was identified as being a necessity. The barriers to implementing health equity initiatives included lack of accountability, leadership support, resources, and institutional awareness. The facilitators included the presence of support for the barriers.
There is a myriad of health equity initiatives taking place in Canadian pediatric tertiary care centers, which are in evolution.