IntroductionPromoting health equity is a key goal of many public health systems. However, little isknown about how equity is conceptualized in such systems, particularly as standards ofpractice are established. As part of a larger study examining the renewal of public health intwo Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis ofrelevant public health documents related to equity. The aim of this paper is to discuss howequity is considered within documents that outline standards for public health.
Methods:
A research team consisting of policymakers and academics identified key documents relatedto the public health renewal process in each province. The documents were analyzed usingconstant comparative analysis to identify key themes related to the conceptualization andintegration of health equity as part of public health renewal in Ontario and BC. Documentswere coded inductively with higher levels of abstraction achieved through multiple readings.Sets of questions were developed to guide the analysis throughout the process.
Results:
In both sets of provincial documents health inequities were defined in a similar fashion, as theconsequence of unfair or unjust structural conditions. Reducing health inequities was anexplicit goal of the public health renewal process. In Ontario, addressing "prioritypopulations" was used as a proxy term for health equity and the focus was on existingprograms. In BC, the incorporation of an equity lens enhanced the identification of healthinequities, with a particular emphasis on the social determinants of health. In both, prioritywas given to reducing barriers to public health services and to forming partnerships withother sectors to reduce health inequities. Limits to the accountability of public health toreduce health inequities were identified in both provinces.
Conclusion:
This study contributes to understanding how health equity is conceptualized and incorporatedinto standards for local public health. As reflected in their policies, both provinces haveembraced the importance of reducing health inequities. Both conceptualized this as rooted instructural injustices and the social determinants of health. Differences in theconceptualization of health equity likely reflect contextual influences on the public healthrenewal processes in each jurisdiction.