Health Equity Impact Assessment (HEIA) Workshop for CAMH Senior Management Group

Transcription

1 Health Equity Impact Assessment (HEIA) Workshop for CAMH Senior Management Group Presented by: Ministry of Health and Long-Term Care (MOHLTC), Toronto Central Local Health Integration Network (LHIN) & Centre for Addiction and Mental Health (CAMH)

2 Introductions and why we are here 06/12/2011 2

3 Outline of the workshop Inequity and health in our work LP 5 Value of HEIA LP 5 HEIA 101: How it Works VA 15 Case studies KJM/BA & SMG 40 Report back SMG 10 Reflections SMG 5 Plans going forward KJM 5 06/12/2011 3

4 Introductions Speakers and development: Vanessa Ambtman: Toronto Central Local Health Integration Network (LHIN) Lisa Price: Ministry of Health and Long-Term Care Kwame McKenzie: Director of Health Equity CAMH Development: Branka Agic: Manager Health Equity, CAMH Anthony Mohammed: St. Michaels Hospital and TC LHIN 06/12/2011 4

5 Why are we here? Because: Health equity is increasingly important Ethical imperative: e.g. the greatest benefit for the most people & at a service level, equity = quality Law & compliance with Excellent Health Care FOR ALL Keeping our strategic planning promises and our Health Equity Plan 06/12/2011 5

6 Legal and ethical responsibilities for integration of equity into planning and decision making In the Excellent Care for All Act, 2010 (ECFA) preamble, equity is defined as a critical component of quality health care. The Local Heath System Integration Act, 2006 (LHSIA) preamble states that: (f) the health system should be guided by a commitment to equity and respect for diversity in communities in serving the people of Ontario and respect the requirements of the French Language Services Act in serving Ontario s French-speaking community; (g) recognize the role of First Nations and Aboriginal peoples in the planning and delivery of health services in their communities The French Language Services Act, 1986 (FLSA) defines where individuals are guaranteed to receive service in French. There are both ethical and legal obligations to address health equity (Canada Health Act, Future of Medicare Act, Charter of Rights and Freedoms, Ontario Human Rights Code) 06/12/2011 6

7 What will we do today? Learn about Health Equity Impact Assessment (HEIA) Be introduced to a HEIA tool Have hands on experience of using the HEIA tool Identify position of SMG going forward and needs for support 06/12/2011 7

8 What is the model of education Knowledge presentation today and background documents on the website Attitudes presentation, fundamental values of your profession and shared goals of CAMH, TC LHIN and MOHLTC Skills practice today, workbook and support and coaching going forward Need for people to be present 06/12/2011 8

9 Reminder Health equity impact assessment is just one of a number of tools that can be deployed to promote equity in health service provision and outcome. It is used as part of a comprehensive strategy to improve equity 06/12/2011 9

10 Questions 06/12/

11 Inequity and health in our work 06/12/

12 Health equity is most often defined by the absence of health inequities or disparities Health inequities or disparities are differences in the health outcomes of specific populations that are systemic, patterned, unfair, unjust, and actionable, as opposed to random or caused by those who become ill. * - Margaret Whitehead *Margaret M. Whitehead, The Concepts and Principles of Equity and Health, 22(3) International Journal of Health Services (1992): /12/

13 Inequities and social determinants have contributed to a difference in life expectancy of 28 years in Glasgow A difference of 16 km in Scotland can result in a 28 year drop in life expectancy A boy from the poor Glasgow suburb of Calton could expect to live to 54, while a boy born in nearby affluent Lenzie is likely to reach Social Factors Key to Ill Health BBC Video 2 06/12/

14 How it connects locally: Average Household Income, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; /12/

15 How it connects locally: Concentration of Visible Minority Populations, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; /12/

16 How it connects locally: Age-Sex-Adjusted Diabetes Rates, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; /12/

17 How it connects locally: Those at lower income levels are significantly more likely to be hospitalized for depression Source: Lin E, Diaz-Granados N, Stewart D, Rhodes A, Yeritsyan N, Johns A, Duong-Hua M, Bierman AS. Depression. In: Bierman AS,editor. Project for an Ontario Women s Health Evidence-Based Report: Volume 1: Toronto;

18 Value of HEIA 06/12/

19 Health Equity Impact Assessment (HEIA) helps users to align services with need enabling better health outcomes Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 19

20 In this simplified example, there is a good alignment between high need and high service provision: a desirable situation Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 20

21 In this simplified example, those with the most need get the lowest level of service: the undesirable inverse care law Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 21

22 HEIA implementation has been staged, with continued active MOHLTC, LHIN and health sector collaboration HEIA Tool was launched on March 25, 2011 Targeted HEIA training for each of the 14 LHINs was completed in August 2011 LHINs have committed to applying HEIA in 2011/12 Continuing to work collaboratively with LHINs and key provincial stakeholders (e.g. CAMH) to identify opportunities for regional implementation, HEIA alignment and evaluation Developing further resources for HEIA users that will be made available on the HEIA website (i.e. community profiles, etc.) HEIA training to MOHLTC staff is taking place over the Fall and Winter /12/

23 HEIA Website and Contact Information HEIA webpage was established on the MOHLTC public website and provides public access to the HEIA Tool and associated resources: English: French: HEIA account established to facilitate continued cross-sectoral engagement

24 HEIA 101: how it works 06/12/

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26 The HEIA tool includes a template and workbook which provide step-by-step instructions on how to complete the HEIA template

27 What is HEIA? HEIA involves 4 key steps: To help you get started: Ensure that you have a clear description/understanding of the policy, program or decision that will be run through the tool. Also, ensure that you have identified and gathered required evidence to inform your analysis. Step 1. Scoping Consider and identify affected populations (this includes intersecting populations and relevant social determinants of health) Step 2. Impact Assessment Identify and record the potential unintended (negative/positive) impacts of the planned policy, program, decision Step 3. Mitigation Identify and record the best ways to reduce the potential negative impacts and amplify the (unintended) positive impacts Step 4. Monitoring Articulate how success could be measured for each mitigation strategy you have identified. 06/12/

28 Step 1. Scoping Consider and identify affected populations (including intersecting populations and relevant SDoH)

29 Step 2. Impact Assessment Identify and record the potential unintended (negative/positive) impacts of the planned policy, program, decision

30 Step 3. Mitigation Identify and record the best ways to reduce the potential negative impacts and amplify the (unintended) positive impacts

31 Step 4. Monitoring Articulate how success could be measured for each mitigation strategy you have identified.

32 Questions 06/12/

33 Where do you come in? Need to: Think of the health equity impact of ALL your decisions Understand when a HEIA is needed Be able to do quick initial scoping and decide whether further work needs to be done Understand the findings of a HEIA 06/12/

34 Case Study: Schizophrenia program decides to colocate two outpatient programs 06/12/

35 What are the two programs Central Link - Parliament & King: bus and street car Spectrum Pape & Danforth: access bus and subway Both offer case-management 9-5 Each has 5 WTE case managers and 0.8 WTE physician Spectrum will move to Central Link allowing: more programming, more diverse programming extended hours of service 06/12/

36 Scoping populations Aboriginal First Nations, Inuit, Métis Seniors/elderly Ethno-racial groups Homeless Low income, underemployed, or unemployed people LGBTT 06/12/

37 Scoping possible factors Access for different populations Access for different age groups Impact on existing support network e.g. GP referral pathways and community organisations 06/12/

38 Impact assessment by population Aboriginal First Nations, Inuit, Métis aboriginal services will move from Central Link site Seniors/elderly larger population around Spectrum Ethno-racial groups new immigrants around Central Link Greek and African-Caribbean population Spectrum Homeless bigger homeless population near Central Link 06/12/

39 Impact assessment by population LGBTT Population groups and SHC near to Central Link Low income, underemployed, or unemployed people Current Spectrum clients further to travel? Impact on job security? Central Link nearer to poorer wards so may increase access Social support networks Undermined for Spectrum clients 06/12/

40 Summary Impact potentially positive for: Recent immigrant groups Aboriginal groups Economically marginalised groups Ability to offer services to LGBTT groups Homeless Impact possibly negative for Older population Existing immigrant population Greek/ African Canadian 06/12/

41 Further investigation Pathways to care Most referrals not from local GPS Referrals mainly from inpatient units via STARS Community relationships not well developed Mapping 06/12/

42 Central Link clients by post code Notes: Total Postal 42 Codes: 127; Not Mapped = 1

43 Spectrum clients by post code Notes: Total Postal 43 Codes: 159; Not Mapped = 4

44 Mitigation and Monitoring Possibly overall positive impact on equity but some groups may have negative impact Mitigation possibilities Ensure current GP links maintained Build better community links in new larger area Communication about ease of getting to clinic Discuss extended hours to help those with jobs Monitoring possibilities Monitor changes in demographics of clinic Monitor changes in number of visits by different clinic groups 06/12/

45 Discussion: Is this acceptable? (whole group) 06/12/

46 Case Study (group work) 06/12/

47 Do one Who four groups What we will do initial scoping and highlight possible implications of a current plan How long - 15 minutes Choices - case study or own issues Groups need to do same case study Report back afterwards 06/12/

48 Whole group case study CAMH decides to set up an acute day hospital Site: 250 College Aims: decrease hospital admission, decrease length of stay Format daily programming with individually tailored packages Target population adults with severe mental health problems Exclusions: primary substance misuse diagnosis, over 65 Admission from ED, inpatient & outpatient programs 06/12/

49 Scoping 06/12/

50 Report back 06/12/

51 Impact assessment

52 Discussion: How can Senior Management support HEIA implementation within CAMH? Within the broader mental health and addiction sector? What supports do you need going forward? 06/12/

53 For further assistance, advice, questions or if you have comments, contact: Kwame McKenzie, MD Clinical Director of Health Equity Centre for Addiction and Mental Health (416) ext Vanessa Ambtman Community Engagement Consultant Toronto Central Local Health Integration Network (LHIN) (416) ext. 240 Lisa Price Senior Policy Advisor Population Health and Integration Strategy Unit Ministry of Health and Long-Term Care (416) /12/

54 References (1) Daily Mail, How living in the wrong part of town can cut your life expectancy by 28 years, and CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization (2) BBC News, Social Factors Key to Ill Health, Other Resources: Margaret M. Whitehead, The Concepts and Principles of Equity and Health, 22(3) International Journal of Health Services (1992): Lin E, Diaz-Granados N, Stewart D, Rhodes A, Yeritsyan N, Johns A, Duong-Hua M, Bierman AS. Depression. In: Bierman AS,editor. Project for an Ontario Women s Health Evidence-Based Report: Volume 1: Toronto; Gothenburg Consensus Paper, European Centre for Health Policy, 1999 Health Equity Audit: A Guide for the NHS, UK Department of Health (????) Clarifying Approaches to: health needs assessment, health impact assessment, integrates impact assessment, health equity audit and race equality impact assessment. Health Development Agency, NHS, UK (????) Mahoney M., Simpson S., Harris E., Aldrich R., Stewart Williams J. (2004) Equity Focused Health Impact Assessment Framework, the Australasian Collaboration for Health Equity Impact Assessment (ACHEIA) Parry J, and Scully E. Health impact assessment and the consideration of health inequalities. Journal of Public Health Medicine, 25(3): 243-5, Mackenbach J, Lennert Veerman J, Barendregt J, and Kunst A. Health inequalities in HIA. In: Kemm J, Parry J and Palmer S.(eds). Health impact assessment: concepts, theory and applications. Oxford: Oxford University Press, ch. 3, /12/

55 Appendix

56 Canada recognizes a number of key social determinants of health, which also have a powerful influence on health outcomes Key Determinants of Health (Public Health Agency of Canada) Income and Social Status Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health Services Gender Culture 06/12/

57 There is regional variation in rates of depression across LHINs, ranging from % of the total population Source: Lin E, Diaz-Granados N, Stewart D, Rhodes A, Yeritsyan N, Johns A, Duong-Hua M, Bierman AS. Depression. In: Bierman AS,editor. Project for an Ontario Women s Health Evidence-Based Report: Volume 1: Toronto;

58 Within Ontario there is regional variation in rates of physician visit following a hospitalization for depression Source: Lin E, Diaz-Granados N, Stewart D, Rhodes A, Yeritsyan N, Johns A, Duong-Hua M, Bierman AS. Depression. In: Bierman AS,editor. Project for an Ontario Women s Health Evidence-Based Report: Volume 1: Toronto;

59 The POWER Study demonstrates that Ontario women have significantly higher rates of depression than their male cohorts Source: Lin E, Diaz-Granados N, Stewart D, Rhodes A, Yeritsyan N, Johns A, Duong-Hua M, Bierman AS. Depression. In: Bierman AS,editor. Project for an Ontario Women s Health Evidence-Based Report: Volume 1: Toronto;

60 A real life example from the UK demonstrates how HEIA can result in both cost savings and improved health outcomes Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 60