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Tackling health inequalities: moving theory to action.

Signal L, Martin J, Reid P, Carroll C, Howden-Chapman P, Ormsby VK, Richards R, Robson B, Wall T - Int J Equity Health (2007)

Bottom Line: This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing.The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training.This New Zealand experience provides a model that may be applicable in other jurisdictions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Otago, Wellington, New Zealand. louise.signal@otago.ac.nz.

ABSTRACT

Background: This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing.

Methods: The workshops were based on a multi-method needs assessment with senior staff in key health institutions. The workshops aimed to increase the knowledge and skills of health sector staff to act on, and advocate for, eliminating inequalities in health. They were practical, evidence-based, and action oriented and took a social approach to the causes of inequalities in health. The workshops used ethnicity as a case study and explored racism as a driver of inequalities. They focused on the role of institutionalized racism, or racism that is built into health sector institutions. Institutional theory provided a framework for participants to analyse how their institutions create and maintain inequalities and how they can act to change this.

Results: Participants identified a range of institutional mechanisms that promote inequalities and a range of ways to address them including: undertaking further training, using Māori (the indigenous people) models of health in policy-making, increasing Māori participation and partnership in decision making, strengthening sector relationships with iwi (tribes), funding and supporting services provided 'by Māori for Māori', ensuring a strategic approach to intersectoral work, encouraging stronger community involvement in the work of the institution, requiring all evaluations to assess impact on inequalities, and requiring the sector to report on progress in addressing health inequalities. The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training.

Discussion: Government and sector leadership were critical to the success of the workshops and subsequent changes in policy and practice. The use of locally adapted equity tools, requiring participants to develop action plans, and using a case study to focus discussion were important to the success for the training. Using institutional theory was helpful in analysing how drivers of inequalities, such as racism, are built into health institutions. This New Zealand experience provides a model that may be applicable in other jurisdictions.

No MeSH data available.


Action Spectrum on Inequalities in Health.
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Figure 2: Action Spectrum on Inequalities in Health.

Mentions: In anonymous written evaluations of the training, 90% of participants rated the workshop as valuable or better. The level of participants' commitment to tackling inequalities was measured at the beginning and end of the workshops using Whitehead's action spectrum on inequalities in health (see Figure 2)[22]. Whitehead argues that countries can move along this spectrum, from measuring health inequalities to recognition of disparities and an awareness of health determinants and consequences. Once awareness is raised, they may be concerned about, deny or be indifferent to inequalities. If there is concern, countries may develop a will to take action and move through a process from isolated initiatives to more structured developments and ultimately to a comprehensive co-ordinated policy. In the workshop evaluations the training team applied Whitehead's model to individuals and found it a useful extension of her work. Nearly all participants moved at least one step and all but two rated themselves as willing to take action following the workshops.


Tackling health inequalities: moving theory to action.

Signal L, Martin J, Reid P, Carroll C, Howden-Chapman P, Ormsby VK, Richards R, Robson B, Wall T - Int J Equity Health (2007)

Action Spectrum on Inequalities in Health.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2100053&req=5

Figure 2: Action Spectrum on Inequalities in Health.
Mentions: In anonymous written evaluations of the training, 90% of participants rated the workshop as valuable or better. The level of participants' commitment to tackling inequalities was measured at the beginning and end of the workshops using Whitehead's action spectrum on inequalities in health (see Figure 2)[22]. Whitehead argues that countries can move along this spectrum, from measuring health inequalities to recognition of disparities and an awareness of health determinants and consequences. Once awareness is raised, they may be concerned about, deny or be indifferent to inequalities. If there is concern, countries may develop a will to take action and move through a process from isolated initiatives to more structured developments and ultimately to a comprehensive co-ordinated policy. In the workshop evaluations the training team applied Whitehead's model to individuals and found it a useful extension of her work. Nearly all participants moved at least one step and all but two rated themselves as willing to take action following the workshops.

Bottom Line: This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing.The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training.This New Zealand experience provides a model that may be applicable in other jurisdictions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Otago, Wellington, New Zealand. louise.signal@otago.ac.nz.

ABSTRACT

Background: This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing.

Methods: The workshops were based on a multi-method needs assessment with senior staff in key health institutions. The workshops aimed to increase the knowledge and skills of health sector staff to act on, and advocate for, eliminating inequalities in health. They were practical, evidence-based, and action oriented and took a social approach to the causes of inequalities in health. The workshops used ethnicity as a case study and explored racism as a driver of inequalities. They focused on the role of institutionalized racism, or racism that is built into health sector institutions. Institutional theory provided a framework for participants to analyse how their institutions create and maintain inequalities and how they can act to change this.

Results: Participants identified a range of institutional mechanisms that promote inequalities and a range of ways to address them including: undertaking further training, using Māori (the indigenous people) models of health in policy-making, increasing Māori participation and partnership in decision making, strengthening sector relationships with iwi (tribes), funding and supporting services provided 'by Māori for Māori', ensuring a strategic approach to intersectoral work, encouraging stronger community involvement in the work of the institution, requiring all evaluations to assess impact on inequalities, and requiring the sector to report on progress in addressing health inequalities. The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training.

Discussion: Government and sector leadership were critical to the success of the workshops and subsequent changes in policy and practice. The use of locally adapted equity tools, requiring participants to develop action plans, and using a case study to focus discussion were important to the success for the training. Using institutional theory was helpful in analysing how drivers of inequalities, such as racism, are built into health institutions. This New Zealand experience provides a model that may be applicable in other jurisdictions.

No MeSH data available.